2021-22 Beaumont ISD Benefit Guide by Higginbotham Public Sector

BEAUMONT ISD

BENEFIT GUIDE EFFECTIVE: 09/01/2021 - 8/31/2022 WWW.MYBENEFITSHUB.COM/BEAUMONTISD 1

Table of Contents Benefit Contact Information How to Enroll Annual Benefit Enrollment 1. Benefit Updates 2. Section 125 Cafeteria Plan Guidelines 3. Annual Enrollment 4. Eligibility Requirements 5. Helpful Definitions 6. Medical Rate Sheet Texas School Health Benefits (TSHB) Program TRS Medical American Public Life Hospital Indemnity MDLIVE Telehealth MetLife Dental UnitedHealthCare Vision Cigna Long-Term Disability American Public Life Cancer The Hartford Accident AUL a OneAmerica Life and AD&D Texas Life Individual Life UNUM Critical Illness ID Watchdog Identity Theft Deer Oaks EAP NBS Flexible Spending Account MASA Emergency Transportation 2

3 4-5 6-11 6 7 8 9 10 11 12-17 18-21 22-25 26-27 28-33 34-37 38-43 44-49 50-53 54-59 60-61 62-65 66-69 70-71 72-75 76-77

FLIP TO... PG. 4

HOW TO ENROLL

PG. 6

SUMMARY PAGES

PG. 12

YOUR BENEFITS

Benefit Contact Information BENEFIT ADMINISTRATORS Financial Benefit Services (800) 583-6908 www.mybenefitshub.com/beaumontisd

EAP Deer Oaks (866) 327-2400 www.deeroaks.com

TELEHEALTH MDlive (888) 365-1663 www.consultmdlive.com

TRS ACTIVECARE MEDICAL Blue Cross Blue Shield (866) 355-5999 www.bcbstx.com/trsactivecare

VISION UnitedHealthCare (800) 638-3120 www.myuhcvision.com

IDENTITY THEFT IDWatchdog (866) 513-1518 www.idwatchdog.com

LIFE AND AD&D AUL a OneAmerica Company (800) 537-6442 www.oneamerica.com

EDUCATOR DISABILITY Cigna (800) 362-4462 www.cigna.com

ACCIDENT The Hartford (866)-547-4205 www.thehartford.com/

HOSPITAL INDEMNITY American Public Life (800) 256-8606 www.ampublic.com

CANCER American Public Life (800) 256-8606 www.ampublic.com

FLEXIBLE SPENDING ACCOUNT (FSA) National Benefit Services (800) 274-0503 www.nbsbenefits.com

DENTAL MetLife (800) 942-0854 www.metlife.com/dental

CRITICAL ILLNESS UNUM Claims (800)635-5597 www.mybenefitshub.com/beaumontisd

COBRA (DENTAL, VISION, FSA) National Benefit Services (800) 274-0503 www.nbsbenefits.com

EMERGENCY TRANSPORTATION MASA (800) 423-3226 www.masamts.com

INDIVIDUAL LIFE Texas Life (800) 283-9233 www.texaslife.com

COBRA (Medical) Bswift, LLC (833) 682-8972

TRS PRESCRIPTION INFO CVS Caremark (800) 222-9205 https://info.caremark.com/trsactivecare

TEXAS SCHOOLS HEALTH BENEFITS PLAN Financial Benefit Services (888) 803-0081 https://tshbp.info/CCVideo

MOBILE APP DOWNLOAD Enrollment made simple through the new FBS Benefits App! Text “FBS BEAUMONT” to (800) 583-6908

and get access to everything you need to complete your benefits

“FBS BEAUMONT” to (800) 583-6908

enrollment: •

Enrollment Resources

•

Online Support

•

Interactive Tools

•

And more!

App Group #: FBSBEAUMONT

Text

OR SCAN

How to Log In

1 BENEFIT INFO

INTERACTIVE TOOLS

2 3

www.mybenefitshub.com/ beaumontisd

CLICK LOGIN

ENTER USERNAME & PASSWORD All login credentials have been RESET to the default described below:

Username: The first six (6) characters of your last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number.

ONLINE SUPPORT

If you have less than six (6) characters in your last name, use your full last name, followed by the first letter of your first name, followed by the last four (4) digits of your Social Security Number.

Default Password: Last Name (lowercase, excluding punctuation) followed by the last four (4) digits of your Social Security Number.

Annual Benefit Enrollment Benefit Updates - What’s New: NEW! TSHBP MEDICAL • Now includes out-of-network coverage NEW! ACCIDENT PLAN • Expanded coverage • Lower premiums • Provided by The Hartford NEW! HOSPITAL INDEMNITY PLAN • Revised and lower rates NEW! TRS-ACTIVECARE CHANGES • Rate increased for all plans. • For ACHD plan: deductible, out-of-pocket maximum, and coinsurance increased.

Don’t Forget! • Login and complete your benefit enrollment from 07/12/2021 - 08/06/2021 • Enrollment assistance is available by calling Financial Benefit Services at (866) 914-5202. Hours are Monday Friday 8am-7pm. Bilingual assistance is available. • Update your profile information: home address, phone numbers, email, beneficiaries • REQUIRED: Provide correct dependent social security numbers

SUMMARY PAGES

Section 125 Cafeteria Plan Guidelines A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. All enrollments in pretax benefits are subject to Cafeteria Plan rules; all eligible benefits (medical, medlink, dental, vision, cancer, accident, and FSA) will be pre-taxed. Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year. CHANGES IN STATUS (CIS):

Marital Status

Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 31 days of your qualifying event and meet with your Benefit/HR Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.

QUALIFYING EVENTS A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).

A change in number of dependents includes the following: birth, adoption and placement for adoption. Change in Number of Tax You can add existing dependents not previously enrolled whenever a dependent gains eligibility as a Dependents result of a valid change in status event. Change in Status of Employment Affecting Coverage Eligibility

Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual's eligibility under an employer's plan includes commencement or termination of employment.

An event that causes an employee's dependent to satisfy or cease to satisfy coverage requirements Gain/Loss of Dependents' under an employer's plan may include change in age, student, marital, employment or tax dependent Eligibility Status status. If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order Judgment/Decree/Order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual's plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage. Eligibility for Government Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change. Programs

SUMMARY PAGES

Annual Enrollment During your annual enrollment period, you have the opportunity

Where can I find forms?

to review, change or continue benefit elections each year.

For benefit summaries and claim forms, go to your benefit

Changes are not permitted during the plan year (outside of annual

website: www.mybenefitshub.com/beaumontisd. Click on the

enrollment) unless a Section 125 qualifying event occurs.

benefit plan you need information on (i.e., Dental) and you can find the forms you need under the Benefits and Forms

•

Changes, additions or drops may be made only during the

section.

annual enrollment period without a qualifying event. How can I find a Network Provider?

• Employees must review their personal information and verify that dependents they wish to provide coverage for are

ISD benefit website: www.mybenefitshub.com/beaumontisd.

included in the dependent profile. Additionally, you must

Click on the benefit plan you need information on (i.e.,

notify your employer of any discrepancy in personal and/or benefit information.

•

For benefit summaries and claim forms, go to the Beaumont

Employees must confirm on each benefit screen (medical, dental, vision, etc.) that each dependent to be covered is selected in order to be included in the coverage for that particular benefit.

Dental) and you can find provider search links under the Quick

Links section. When will I receive ID cards? If the insurance carrier provides ID cards, you can expect to receive those 3-4 weeks after your effective date. For most dental and vision plans, you can login to the carrier website and print a temporary ID card or simply give your provider the insurance company’s phone number and they can call and

New Hire Enrollment All new hire enrollment elections must be completed in the online enrollment system within the first 31 days of benefit eligibility employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.

verify your coverage if you do not have an ID card at that time. If you do not receive your ID card, you can call the carrier’s customer service number to request another card. If the insurance carrier provides ID cards, but there are no changes to the plan, you typically will not receive a new ID card each year.

Q&A Who do I contact with Questions? For supplemental benefit questions, you can contact your Benefits Department or you can call Financial Benefit Services at 866-914-5202 for assistance.

SUMMARY PAGES

Employee Eligibility Requirements

Dependent Eligibility Requirements

Supplemental Benefits: Eligible employees must work 20 or more

Dependent Eligibility: You can cover eligible dependent

regularly scheduled hours each work week.

children under a benefit that offers dependent coverage,

Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if your

provided you participate in the same benefit, through the maximum age listed below. Dependents cannot be double covered by married spouses within the district as both employees and dependents.

2021 benefits become effective on September 1, 2021, you must be actively-at-work on September 1, 2021 to be eligible for your new benefits. PLAN

CARRIER

MAXIMUM AGE

Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.

Dental

Metlife

To 26

Vision

United Healthcare

Unmarried to 26

Life

OneAmerica

Unmarried to 26

Potential Spouse Coverage Limitations: When enrolling in coverage, please keep in mind that some benefits may not allow you to cover your spouse as a dependent if your spouse is enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on spouse eligibility.

Hospital Indemnity

American Public Life

To 26

Cancer

APL

To 26

Accident

The Hartford

To 26

Critical Illness

UNUM

Unmarried to 26

Telehealth

MDLIVE

Unmarried to 26

ID Theft Protection

IDWatchdog

Unmarried to 26

Disability

Cigna

N/A

Individual Life

Texas Life

To 26

FSA/HSA Limitations: Please note, in general, per IRS regulations, married couples may not enroll in both a Flexible Spending Account (FSA) and a Health Savings Account (HSA). If your spouse is covered under an FSA that reimburses for medical expenses then you and your spouse are not HSA eligible, even if you would not use your spouse's FSA to reimburse your expenses. However, there are some exceptions to the general limitation regarding specific types of FSAs. To obtain more information on whether you can enroll in a specific type of FSA or HSA as a married couple, please reach out to the FSA and/or HSA provider prior to enrolling or reach out to your tax advisor for further guidance. Potential Dependent Coverage Limitations: When enrolling for dependent coverage, please keep in mind that some benefits may not allow you to cover your eligible dependents if they are enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on dependent eligibility. Disclaimer: You acknowledge that you have read the limitations and exclusions that may apply to obtaining spouse and dependent coverage, including limitations and exclusions that may apply to enrollment in Flexible Spending Accounts and Health Savings Accounts as a married couple. You, the enrollee, shall hold harmless, defend, and indemnify Financial Benefit Services, LLC from any and all claims, actions, suits, charges, and judgments whatsoever that arise out of the enrollee's enrollment in spouse and/or dependent coverage, including enrollment in Flexible Spending Accounts and Health Savings Accounts.

If your dependent is disabled, coverage may be able to continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your HR/Benefit Administrator to request a continuation of coverage. 9

SUMMARY PAGES

Helpful Definitions Actively at Work You are performing your regular occupation for the employer on a full-time basis, either at one of the employer’s usual

Doctors, hospitals, optometrists, dentists and other providers who have contracted with the plan as a network provider.

places of business or at some location to which the employer’s

Out of Pocket Maximum

business requires you to travel. If you will not be actively at

The most an eligible or insured person can pay in co-insurance

work beginning 9/1 please notify your benefits administrator.

for covered expenses.

Annual Enrollment

Plan Year

The period during which existing employees are given the

September 1st through August 31st

opportunity to enroll in or change their current elections.

Pre-Existing Conditions Annual Deductible

Applies to any illness, injury or condition for which the

The amount you pay each plan year before the plan begins to

participant has been under the care of a health care provider,

pay covered expenses.

taken prescriptions drugs or is under a health care provider’s orders to take drugs, or received medical care or services

Calendar Year January 1st through December 31st

Co-insurance After any applicable deductible, your share of the cost of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service.

Guaranteed Coverage The amount of coverage you can elect without answering any medical questions or taking a health exam. Guaranteed coverage is only available during initial eligibility period. Actively-at-work and/or pre-existing condition exclusion provisions do apply, as applicable by carrier.

In-Network 10

(including diagnostic and/or consultation services).

Medical Plan Options

SUMMARY PAGES

2021-2022 Monthly Premiums

TSHBP HDHP Employee Only Employee and Spouse Employee and Child(ren) Employee and Family

Monthly Premium $352.00 $1,018.00 $672.00 $1,287.00

Employer Contribution $352.00 $460.00 $460.00 $460.00

Employee Cost $0.00 $558.00 $212.00 $827.00

TSHBP CoPay Plan Employee Only Employee and Spouse Employee and Child(ren) Employee and Family

Monthly Premium $395.00 $1,185.00 $763.00 $1,490.00

Employer Contribution $395.00 $460.00 $460.00 $460.00

Employee Cost $0.00 $725.00 $303.00 $1,030.00

TRS ActiveCare HD Employee Only Employee and Spouse Employee and Child(ren) Employee and Family

Monthly Premium $429.00 $1,209.00 $772.00 $1,445.00

Employer Contribution $429.00 $460.00 $460.00 $460.00

Employee Cost $0.00 $749.00 $312.00 $985.00

TRS ActiveCare 2 Employee Only Employee and Spouse Employee and Child(ren) Employee and Family

Monthly Premium $1,013.00 $2,402.00 $1,507.00 $2,841.00

Employer Contribution $460.00 $460.00 $460.00 $460.00

Employee Cost $553.00 $1,942.00 $1,047.00 $2,381.00

TRS ActiveCare Primary Employee Only Employee and Spouse Employee and Child(ren) Employee and Family

Monthly Premium $417.00 $1,176.00 $751.00 $1,405.00

Employer Contribution $417.00 $460.00 $460.00 $460.00

Employee Cost $0.00 $716.00 $291.00 $945.00

TRS ActiveCare Primary+ Employee Only Employee and Spouse Employee and Child(ren) Employee and Family

Monthly Premium $542.00 $1,334.00 $879.00 $1,675.00

Employer Contribution $460.00 $460.00 $460.00 $460.00

Employee Cost $82.00 $874.00 $419.00 $1,215.00

Beaumont ISD Alternative Medical Plan Offered by TSHBP

YOUR BENEFITS PACKAGE

About this Benefit BISD and the TSHBP are proud to offer a variety of plans and benefits to meet the needs of BISD employees. Plans for 2021-22 include our High Deductible Health Plan (HDHP) and our CoPay Plan (CPP). Both plans are designed so members can easily navigate through their health medical needs.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 12 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Beaumont ISD Benefits Website: www.mybenefitshub.com/beaumontisd

Texas Schools Health Benefits Plan About Texas Schools Health Benefits Program (TSHBP) The Texas Schools Health Benefits Program is a regionally rated program developed for Texas school districts. Our purpose is to support the school children of Texas. We do this by providing health benefit solutions to our dedicated teachers, administrators, and support staff so they can concentrate on what they do best – teaching and supporting our kids. It is our desire to increase member health and well-being and provide tools necessary to identify and manage the health of each and every member. TSHBP plans are available for school district employees who are employed by participating districts and are active, contributing TRS members.

Both TSHBP Plans Include •

A Nationwide Network for Physician and Ancillary Services. Both In and Out of Network physician and Ancillary Services are covered

•

No primary care provider required or referral to a specialist. A member can use any provider in the network or out of the network

•

A Care Coordinator service (personal concierge) to support members with all their medical needs and specifically assist them with all facility care

•

Specialty drugs over $670 (30 day supply) are not covered, but the plan offers Patient Assistance and Co-Pay assistance

•

A patient advocate to help members with any balance bill and to pay the bill on the members behalf if necessary

•

ACA Preventative Services are paid at 100% and all copays and deductibles are waived

TSHBP High Deductible Highlights •

Significantly lower premium rates compared to the TRS-

TSHBP Co-Pay Highlights •

ActiveCare HD plan •

Lower out-of-pocket maximums since a member-only have

A unique plan that members pay only copayments for service. All copayments apply to the deductible

•

to meet their deductible (no coinsurance)

Lower out-of-pocket maximums since a member-only have to meet their deductible (no coinsurance)

•

TSHBP HD - $3,000

•

TSHBP CoPay - $3,500

•

In comparison with TRSAC HD - $7,000

•

In comparison with TRSAC Primary - $8,150

•

Telehealth at a $30 Consultation Fee

•

Telehealth at $0 Copay

•

All eligible prescriptions are paid at 100% after the

•

$0 copay for generic drugs at CVS, HEB, Wal-Mart, Sam’s,

deductible

and Costco ($10 copay at other network pharmacies)

Texas Schools Health Benefits Plan—HD Plan Plan Plan Summary TSHBP HD Plan Plan Features

HOW DOES TSHBP COMPARE TO TRS? Our unique embedded deductible health plans offer members lower out-of pocket maximums, bringing substantial savings without sacrificing care or quality.

Network Plan Deductible Feature Individual/Family Deductible Individual/Family Maximum Out-of- Pocket Health Savings Account (HSA) Eligible Required - Primary Care Provider (PCP) Required - PCP Referral to Specialist Prescription Drug Benefits

In-Network Coverage

Out-of-Network Coverage

HealthSmart - National Deductible, then Plan pays 100% $3,000/$9,000

N/A Deductible, then Plan pays 100% $3,500/$9,500

$3,000/$9,000

$3,500/$9,500

Yes

Yes - Deductible, then Plan pays 100%

Yes - $0 copay $30 per consultation Deductible, then Plan pays 100% Deductible, then Plan pays 100%

Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100%

Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100%

Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% In-Network Only In-Network Only In-Network Only

Deductible, then Plan pays 100%

In-Network Only

Deductible, then Plan pays 100%

In-Network Only

Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100% Deductible, then Plan pays 100%

Deductible, then Plan pays 100%* Deductible, then Plan pays 100%* Deductible, then Plan pays 100%* Deductible, then Plan pays 100%* In-Network Only

Doctor Visits Preventive Care Virtual Health - Teladoc Primary Care Specialist

Office Services

WHAT ARE CARE COORDINATORS? The Care Coordinators act as a personal concierge for all TSHBP plans and members, and their job is to support the member as their healthcare advocate. Watch the below video to learn more.

Allergy Injections Allergy Serum Chiropractic Services Office Surgery MRI’s, Cat Scans, and Pet Scans Urgent Care Facility

Care Facilities Urgent Care Facility Freestanding Emergency Room Hospital Emergency Room Ambulance Services Outpatient Surgery Hospital Services Surgeon Fees

Maternity and Newborn Services Maternity Charges (prenatal and postnatal care) Routine Newborn Care

Rehabilitation/Therapy

https://tshbp.info/CCVideo

Occupational/Speech/Physical Cardiac Rehabilitation Chemotherapy, Radiation, Dialysis Home Health Care Skilled Nursing

Care Coordinator* The Care Coordinator program must be used to access facility services or no benefits will be available under the Plan. These services include routine colonoscopy and related services; hospital providers for MRIs, Cat Scans, and Pet Scans; hospital providers for outpatient Lab/Radiology Services; Inpatient Hospital Admissions; Outpatient Hospital/Ambulatory Surgical Facility Services; Maternity and Newborn Services; Rehabilitation/Therapy Services; Extended Care Services; and Other Services including durable medical equipment/supplies, orthotics/ prosthetics, facilities for diabetic self-management training, and sleep disorder services. To review the complete plan document and services that require access through the Care Coordinator program, please call 888-803-0081.

Texas Schools Health Benefits Plan—CoPay Plan Plan Summary TSHBP CoPay Plan Plan Features

HOW DOES TSHBP COMPARE TO TRS? Our unique embedded deductible health plans offer members lower out-of pocket maximums, bringing substantial savings without sacrificing care or quality.

In-Network Coverage

Out-of-Network Coverage

HealthSmart - National Copayments, then Plan pays 100% $3,500/$10,500

N/A Copayments, then Plan pays 100% $4,000/$11,000

$3,500/$10,500

$4,000/$11,000

Yes - Copayments, then Plan pays 100%

Yes - $0 copay $0 per consultation $35 copay $35 copay

Yes - $0 copay $0 per consultation $40 copay $40 copay

$5 copay $35 copay $35 copay $110 copay $275 copay $50 copay

$10 copay $40 copay $40 copay $125 copay $325 copay $75 copay

$50 copay $500 copay $500 copay $220 copay $500 copay $500 copay $100 copay

$75 copay $500 copay $500 copay $220 copay In-Network Only In-Network Only In-Network Only

$500 copay

In-Network Only

$250 copay

In-Network Only

$55 copay $110 copay $110 copay $55 copay $500 copay

$65 copay* $125 copay* $125 copay* $75 copay* In-Network Only

Doctor Visits Preventive Care Virtual Health - Teladoc Primary Care Specialist

Office Services

Allergy Injections Allergy Serum Chiropractic Services Office Surgery MRI’s, Cat Scans, and Pet Scans Urgent Care Facility

Care Facilities Urgent Care Facility Freestanding Emergency Room Hospital Emergency Room Ambulance Services Outpatient Surgery Hospital Services Surgeon Fees

Maternity and Newborn Services Maternity Charges (prenatal and postnatal care) Routine Newborn Care

Rehabilitation/Therapy

https://tshbp.info/CCVideo

Occupational/Speech/Physical Cardiac Rehabilitation Chemotherapy, Radiation, Dialysis Home Health Care Skilled Nursing

Beaumont ISD Medical Rates 2021-22 The rates below are not inclusive of your district’s medical contribuƟon. Please visit your benefit website for more informaƟon regarding your district’s medical contribuƟon amounts.

TRS‐Ac veCare HD

$429

$772

$1,209

$1,445

TRS‐Ac veCare Primary +

$542

$879

$1,334

$1,675

TRS‐Ac veCare Primary

$417

$751

$1,176

$1,405

TSHBP

HD Plan

$352

$672

$1,018

$1,287

CoPay Plan

$395

$763

$1,185

$1,490

Maximum Out‐of‐Pocket Costs (In-Network) For 2021‐22 Cost for Families

Cost for Individuals $3,000 $3,500

TSHBP CoPay Plan

$9,000 $10,500

$7,000

TRS‐Ac veCare HD

$14,000

$6,900

TRS‐ActiveCare Primary +

$13,800

$8,150

TSHBP HD Plan

TRS‐Ac veCare Primary

$16,300

Texas Schools Health Benefits Cost Examples TRS

PEG IS HAVING A BABY

Deductible

TSHBP

Primary Primary+

Co Pay

$3,000

$2,500

$1,200

$3,000

$3,500

Specialist Coinsurance/Copayment

30%

$70

$35

Hospital Coinsurance/Copayment

30%

20%

$500

Other Coinsurance/Copayment

30%

20%

$250

Total Example Cost

$12,800

Deductibles

$3,000

$2,500

$1,200

$3,000

Copayments

$70

$1,285

Coinsurance

$2,940

$3,000

$2,300

$60

$6,000

$5,630

$3,630

$3,000

$1,285

Limits or Exclusions Total Cost

Compared to TRS-AC HD (savings)

$3,000

Compared to TRS-AC Primary (savings)

$2,345

Compared to TRS-AC Primary + (savings)

$4,345

TOM’S KNEE REPLACEMENT Deductible

TRS HD

TSHBP

Primary Primary+

Co Pay

$3,000

$2,500

$1,200

$3,000

$3,500

Specialist Coinsurance/Copayment

30%

$70

$35

Hospital Coinsurance/Copayment

30%

20%

$500

Other Coinsurance/Copayment

30%

20%

$250

Total Example Cost

$38,000

Deductibles

$3,000

$2,500

$1,200

$3,000

Copayments

$70

$1,385

Coinsurance

$10,500

$10,650

$7,360

$60

$7,000*

$8,150*

$6,900*

$3,000

$1,385

Limits or Exclusions Total Cost

Compared to TRS-AC HD (savings)

$4,000

Compared to TRS-AC Primary (savings)

$6,785

Compared to TRS-AC Primary + (savings)

$5,535

*Out-of-pocket limit

BCBSTX

Medical

YOUR BENEFITS PACKAGE

About this Benefit Major medical insurance is a type of health care coverage that provides benefits for a broad range of medical expenses that may be incurred either on an inpatient or outpatient basis. More than 70% of adults across the United States are already being diagnosed with a chronic disease.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 18 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Beaumont ISD Benefits Website: www.mybenefitshub.com/beaumontisd

2021-22 TRS-ActiveCare Plan Highlights Sept. 1, 2021 — Aug. 31, 2022 All TRS-ActiveCare participants have three plan options. Each includes a wide range of wellness benefits.

TRS-ActiveCare 2 TRS-ActiveCare Primary • Lowest premium of the •

Plan summary

• • • •

Monthly Premiums Employee Only Employee and Spouse Employee and Children Employee and Family

plans Copays for doctor visits before you meet deductible Statewide network PCP referrals required to see specialists Not compatible with a health savings account (HSA) No out-of-network coverage

Total Premium $417 $1,176 $751 $1,405

Your Premium $ $ $ $

(This plan is closed and not accepting new enrollees. If you’re currently enrolled in TRS-ActiveCare 2, you can remain in this plan.)

TRS-ActiveCare Primary+

TRS-ActiveCare HD

• Lower deductible than the HD and

• Compatible with a health savings

• • • • • •

Primary plans Copays for many services and drugs Higher premium than the other plans Statewide network PCP referrals required to see specialists Not compatible with a health savings account (HSA) No out-of-network coverage

Total Premium $542 $1,334 $879 $1,675

account (HSA) • Nationwide network with out-ofnetwork coverage • No requirement for PCPs or referrals • Must meet your deductible before plan pays for non-preventive care

• Closed to new enrollees • Current enrollees can choose to

stay in this plan

• Lower deductible • Copays for many drugs and

services

• Nationwide network with out-of-

network coverage

• No requirement for PCPs or

referrals

Your Premium $ $ $ $

Total Premium $429 $1,209 $772 $1,445

Your Premium $ $ $ $

Total Premium $1,013 $2,402 $1,507 $2,841

Your Premium $ $ $ $

Plan Features Type of Coverage Individual/Family Deductible

In-Network Coverage Only

In-Network

Out-of-Network

In-Network

Out-of-Network

$2,500/$5,000

$1,200/$3,600

$3,000/$6,000

$5,500/$11,000

$1,000/$3,000

$2,000/$6,000

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

You pay 20% after deductible

$8,150/$16,300

$6,900/$13,800

Statewide Network

You pay 50% after deductible $20,250/ $7,000/$14,000 $40,500 Nationwide Network

You pay 40% after deductible $23,700/ $7,900/$15,800 $47,400 Nationwide Network

Yes

Primary Care

$30 copay

Specialist

$70 copay

$0 per consultation

$50 copay

You pay 30% after deductible

You pay 20% after deductible

You pay 30% after deductible

$0 per consultation

$30 per consultation

Drug Deductible Generics (30-Day Supply/ 90-Day Supply)

Integrated with medical $15/$45 copay; $0 for certain generics

$200 brand deductible

Integrated with medical You pay 20% after deductible; $0 for certain generics

Preferred Brand

You pay 30% after deductible

You pay 25% after deductible

Non-preferred Brand

You pay 50% after deductible

Specialty

You pay 30% after deductible

You pay 20% after deductible

Coinsurance Individual/Family Maximum Out-of-Pocket Network Primary Care Provider (PCP) Required

Doctor Visits

TRS Virtual Health

You pay 30% You pay 50% after deductible after deductible You pay 30% You pay 50% after deductible after deductible $30 per consultation

You pay 40% after deductible You pay 40% $70 copay after deductible $0 per consultation $30 copay

Immediate Care Urgent Care Emergency Care TRS Virtual Health

You pay 30% after deductible

You pay 50% after deductible

You pay 40% after deductible You pay a $250 copay plus 20% after deductible $0 per consultation $50 copay

Prescription Drugs $15/$45 copay

How to Calculate Your Monthly Premium

Wellness Benefits at No Extra Cost

Total Monthly Premium

Being healthy is easy with:

Your District and State Contributions

Your Premium Ask your Benefits Administrator for your district’s premiums.

Things to Know • •

TRS’s Texas-sized purchasing power creates broad networks without county boundaries. Specialty drug insurance means you’re covered, no matter what life throws at you.

• • • • •

$0 preventive care 24/7 customer service One-on-one health coaches Weight loss programs Nutrition programs

$200 brand deductible $20/$45 copay You pay 25% after deductible ($40 min/$80 max)/ You pay 25% after deductible ($105 min/$210 max) You pay 50% after deductible ($100 min/$200 max)/ You pay 50% after deductible ($215 min/$430 max) You pay 20% after deductible ($200 min/$900 max)

• • • •

Ovia® pregnancy support TRS Virtual Health Mental health support And much more!

Available for all plans. See your Benefits Booklet for more details.

2021-22 Health Maintenance Organizations: Premiums for Regional Plans Remember: When you choose an HMO, you’re choosing a regional network. TRS also contracts with HMOs in certain regions of the state to bring participants in those areas another option. Central and North Texas Scott and White Care Plan

Blue Essentials — South Texas HMOSM

Brought to you by TRS-ActiveCare

You can choose this plan if you live in one of these counties: Austin, Bastrop, Bell, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Collin, Coryell, Dallas, Denton, Ellis, Erath, Falls, Freestone, Grimes, Hamilton, Hays, Hill, Hood, Houston, Johnson, Lampasas, Lee, Leon, Limestone, Madison, McLennan, Milam, Mills, Navarro, Robertson, Rockwall, Somervell, Tarrant, Travis, Walker, Waller, Washington, Williamson

Total Monthly Premiums Employee Only Employee and Spouse Employee and Children

Employee and Family

Total Premium

Your Premium

You can choose this plan if you live in one of these counties: Cameron, Hildalgo, Starr, Willacy

Total Premium

Your Premium

Blue Essentials — West Texas HMOSM Brought to you by TRS-ActiveCare You can choose this plan if you live in one of these counties: Andrews, Armstrong, Bailey, Borden, Brewster, Briscoe, Callahan, Carson, Castro, Childress, Cochran, Coke, Coleman, Collingsworth, Comanche, Concho, Cottle, Crane, Crockett, Crosby, Dallam, Dawson, Deaf Smith, Dickens, Donley, Eastland, Ector, Fisher, Floyd, Gaines, Garza, Glasscock, Gray, Hale, Hall, Hansford, Hartley, Haskell, Hemphill, Hockley, Howard, Hutchinson, Irion, Jones, Kent, Kimble, King, Knox, Lamb, Lipscomb, Llano, Loving, Lubbock, Lynn, Martin, Mason, McCulloch, Menard, Midland, Mitchell, Moore, Motley, Nolan, Ochiltree, Oldham, Parmer, Pecos, Potter, Randall, Reagan, Reeves, Roberts, Runnels, San Saba, Schleicher, Scurry, Shackelford, Sherman, Stephens, Sterling, Stonewall, Sutton, Swisher, Taylor, Terry, Throckmorton, Tom Green, Upton, Ward, Wheeler, Winkler, Yoakum

Total Premium

Your Premium

$542.48

$524.00

$596.54

$1,362.70

$1,264.28

$1,443.66

$872.16

$819.60

$936.18

$1,568.42

$1,345.58

$1,532.74

Plan Features Type of Coverage Individual/Family Deductible

In-Network Coverage Only

$1,150/$3,450

$500/$1,000

$950/$2,850

You pay 20% after deductible

You pay 25% after deductible

$7,450/$14,900

$4,500/$9,000

$7,450/$14,900

Primary Care

$20 copay

$25 copay

$20 copay

Specialist

$70 copay

$60 copay

$70 copay

$50 copay

$75 copay

$50 copay

You pay 20% after deductible

$500 copay before deductible and 25% after deductible

Coinsurance Individual/Family Maximum Outof-Pocket

Doctor Visits

Immediate Care Urgent Care Emergency Care

$500 copay after deductible

Prescription Drugs Drug Deductible

$200 (excl. generics)

$100

$150

30-day supply/90-day supply

$10/$25 copay

$10/$30 copay

$5/$12.50 copay; $0 for certain generics

Preferred Brand

You pay 30% after deductible

$40/$120 copay

You pay 30% after deductible

Non-preferred Brand

You pay 50% after deductible

$65/$195 copay

You pay 50% after deductible

You pay 15%/25% after deductible (preferred/non-preferred)

You pay 20% after deductible

You pay 15%/25% after deductible (preferred/non-preferred)

Day Supply Generics

Specialty

trs.texas.gov 20

AMERICAN PUBLIC LIFE YOUR BENEFITS PACKAGE

Hospital Indemnity

About this Benefit Hospital Confinement Indemnity Insurance pays a daily benefit if you have a covered stay in a hospital*, critical care unit and rehabilitation facility. The benefit amount is determined based on the type of facility and the number of days you stay. Hospital Confinement Indemnity Insurance is a limited benefit policy. It is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act.

The median hospital costs per stay have steadily grown to over $10,500 per day.

$9,600

$10,400

$10,700

2008

2012

2018

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 22 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Beaumont ISD Benefits Website: www.mybenefitshub.com/beaumontisd

MedChoice™ Group Limited Benefit Hospital Indemnity Insurance Beaumont ISD HSA Compatible THE INSURANCE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. YOU SHOULD CONSULT YOUR EMPLOYER TO DETERMINE WHETHER YOUR EMPLOYER IS A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM.

Summary of Benefits

Plan 1

Plan 2

Hospital Admission Benefit

$1,500 per day; maximum of 1 day

$2,500 per day; maximum of 1 day

Hospital Confinement Benefit

$200 per day; maximum of 30 days

Intensive Care Unit Benefit

$200 per day; maximum of 30 days

Rehabilitation Benefit

$200 per day; maximum of 5 days

Included

Additional Rider Portability Rider

HSA Compatible Monthly Premiums* Individual Ages 18 +

Individual & Spouse

Individual & Child(ren)

Individual & Family

Plan 1

Plan 2

Plan 1

Plan 2

Plan 1

Plan 2

Plan 1

Plan 2

$15.98

$22.40

$37.04

$46.60

$20.54

$25.40

$38.44

$49.84

* Total premium includes the Plan selected and any applicable rider premium. Premiums are subject to increase with notice. The premium and amount of benefits vary dependent upon the Plan selected at time of application.

Benefits

Benefits are per day, up to the maximum number of days per calendar year, per covered person. Benefit amounts may vary based upon place of service. Benefits will only be paid for a covered loss incurred while covered under the certificate. A covered person is a person who is eligible for coverage under the certificate and for whom the coverage is in force. An eligible dependent means your lawful spouse; your natural, adopted or stepchild who is under the age of 26; and/or any child under the age of 26 who is under your charge, care and control, and who has been placed in your home for adoption, or for whom you are a party in a suit in which adoption of the child is sought; or any child under the age of 26 for whom you must provide medical support under an order issued under Chapter 154 of the Texas Family Code, or enforceable by a court in Texas; or grandchildren under the age of 26 if those grandchildren are your dependents for federal income tax purposes at the time application for coverage of the grandchild is made. Hospital Admission Benefit - Pays a benefit when a covered person is admitted and confined as an inpatient in a hospital due to an injury or covered sickness. APL will not pay this benefit for outpatient treatment, emergency room treatment or a stay less than 18 hours in an observation unit. This benefit is only payable once per period of confinement. A hospital is not an institution, or part thereof, used as a place for rehabilitation, a place for rest or for the aged, a nursing or convalescent home, a long-term nursing unit or geriatrics ward or an extended care facility for the care of convalescent, rehabilitative or ambulatory patients. Hospital Confinement Benefit - Pays a per day benefit when a covered person is confined as an inpatient to a hospital due to an injury or covered sickness. Intensive Care Unit Benefit - Pays a per day benefit when a covered person is confined in an ICU due to an injury or covered sickness. Benefits will be paid beginning the first day of ICU confinement when the ICU confinement begins after the covered person’s effective date. Rehabilitation Benefit - Pays a per day benefit when a covered person is receiving rehabilitation care services while confined in a rehabilitation unit or skilled nursing facility immediately after a covered period of confinement due to an injury or covered sickness. This benefit is not payable in addition to any other confinement benefit provided under the policy on the same day. If more than one confinement occurs on the same day, the higher benefit will be paid.

APSB-22507(TX)-0321 Beaumont ISD

Page 1 of 3

MedChoice™ Group Limited Benefit Hospital Indemnity Insurance Exclusions

No benefits are payable for any loss resulting from or caused, whether directly or indirectly by: hernia, adenoids, tonsils, varicose veins, appendix, disorder of the reproduction organs within six months after the certificate effective date unless due to an emergency; any act of war, declared or undeclared, or any act related to war, or active service in the armed forces, or military service for any country at war; (if coverage is suspended for any covered person during a period of military service, we will refund the pro-rata portion of any premium paid for any such covered person upon receipt of the policyholder’s written request.); dental treatment or routine vision services unless due to injury and if performed within 12 months of the date of the covered accident or due to congenital defect or birth anomaly of a covered newborn child; an intentionally self-inflicted injury or sickness; committing, or attempting to commit, an illegal act that is defined as a felony (felony is as defined by the law of the jurisdiction in which the act takes place); an injury or sickness incurred while engaging in an illegal occupation; cosmetic care, except when the hospital confinement is due to medically necessary reconstructive plastic surgery (medically necessary reconstructive plastic surgery is defined as: surgery to restore a normal bodily function, surgery to improve functional impairment by anatomic alteration made necessary as a result of a congenital birth defect or birth anomaly, breast reconstruction following mastectomy); being intoxicated or under the influence of any narcotic unless administered by a physician or taken according to the physician’s instructions (intoxication means that which is determined and defined by the laws and jurisdiction of the geographical area in which the loss or cause of loss was incurred); experimental treatment, drugs or surgery, except in connection with an approved cancer clinical trial; immunizations; artificial insemination, in vitro fertilization, test tube fertilization, sterilization, tubal ligation or vasectomy, and reversal thereof; participation in any sport for pay or profit; serious mental illness without demonstrable organic disease; alcoholism or drug addiction treatment; services for which payment is not legally required, except for: Medicaid; treatment of non-service connected disabilities in Veterans Administration hospitals and care rendered to armed services retirees and dependents in military medical facilities of the United States Government; voluntary abortion except, with respect to you or your covered eligible dependent spouse: where you or your dependent spouse’s life would be endangered if the fetus were carried to term or where medical complications have arisen from abortion; pregnancy of an eligible dependent child; participating in a riot, insurrection, rebellion, civil commotion, civil disobedience or unlawful assembly (this does not include a loss which occurs while acting in a lawful manner within the scope of authority); participation in a contest of speed in power driven vehicles, parachuting or hang gliding; air travel except as a fare-paying passenger on a commercial airline on a regularly scheduled route or as a passenger for transportation only and not as a pilot or crew member; sex changes; a diagnosis or treatment received outside the United States, or its territories, that cannot be confirmed by a physician licensed and practicing in the United States. The covered person, at his or her own expense, is responsible for obtaining such confirmation.

Termination of Certificate

Your insurance coverage under the certificate, including any attached riders, will end on the earliest of these dates: the date the policy terminates; the date the renewal premium became due once the grace period has ended if the premium remains unpaid; the date you no longer qualify as an insured; or the date of your death.

Termination of Coverage

Your insurance coverage under the policy and/or any attached riders for a covered person will end as follows: the date the policy terminates; the date the certificate terminates; the date the renewal premium became due once the grace period has ended if the premium remains unpaid; the end of the policy period in which we receive a written request from you to terminate the covered person’s covereage; the date a covered person no longer qualifies as an insured; or eligible dependent or the date of the covered person’s death. We may end the coverage of any covered person who submits a fraudulent claim.

Extension of Coverage

Coverage under the certificate will continue for a covered person who is totally disabled on the date coverage ends due to termination of the policy. This continuation of coverage will end the earliest of 90 days; the duration of the total disability or the date the covered person’s coverage is replaced with coverage by the succeeding carrier that provides a level of benefits that is at least substantially equal to the level of benefits provided under this policy. Benefits payable during this extension of coverage is subject to the regular benefit limits of this policy. Premiums will continue to be due during this extension of coverage. For the purpose of this provision only, totally disabled means the complete inability of the covered person to perform all of the substantial and material duties and functions of the individual’s occupation and any other gainful occupation in which the covered person earns substantially the same compensation earned before the disability.

COBRA Continuation of Coverage

This plan may be continued in accordance with the Consolidated Omnibus Reconciliation Act of 1986.

Additional Riders

All riders are part of the policy/certificate to which it is attached and are subject to all the provisions of the policy/certificate that are not in conflict with the provisions of the rider. Portability Rider When your coverage under the Group Limited Benefit Hospital Indemnity Policy terminates for reasons other than non-payment of premium, he/she may elect to continue coverage. APL must receive a completed Portability Election form and payment of the first premium for the portability coverage no later than 30 days after such termination of coverage. The benefits, terms and conditions of the portability coverage will be the same as those under the Group Limited Benefit Hospital Indemnity Policy immediately prior to the date the portability option was elected. No changes may be made to benefit amounts, terms, or conditions after portability has been elected. Portability coverage may include any eligible dependents who were covered under the policy at the time of termination. No eligible dependents may be added to the portability coverage except as provided in the newborn and adopted children provision. Eligible dependents may be removed at any time. Premiums will be adjusted accordingly. Portability coverage will be effective on the day after coverage ends under the Policy. Under the portability coverage, you will no longer be required to be actively at work with the policyholder. Once portability has been elected, no further portability options are available for any person covered under the ported coverage. All future premiums due will be billed directly to you. You are responsible for payment of all premiums for the portability coverage. APL will notify you of the amount of premium due, the frequency of premium payments and the premium due dates. APL will not change the premium rate more than once in any period of six consecutive months and will give you 60 days advance written or electronic notice of any change in rates. 24 APSB-22507(TX)-0321 Beaumont ISD

Page 2 of 3

MedChoice™ Group Limited Benefit Hospital Indemnity Insurance Termination of Portability Rider Prior to Portability: Prior to portability being elected, the rider will terminate on the earliest of: the end of the grace period if the premium remains unpaid; the end of the certificate period in which we receive a request from the policyholder to terminate the rider or the end of the certificate period in which APL terminates the rider. Termination of Portability Coverage: Insurance under the portability privilege will end on the earliest of: the date the master policy terminates; the end of the grace period if the premium for the portability coverage remains unpaid; the end of the certificate period in which we receive a written request from you to terminate the portability coverage; the date of your death; with respect to eligible dependents, the date the covered person no longer qualifies as an eligible dependent. Once insurance under this portability provision is cancelled, it cannot be reinstated.

2305 Lakeland Drive | Flowood, MS 39232 ampublic.com | 800.256.8606 Underwritten by American Public Life Insurance Company. All Riders are subject to all the Provisions, Conditions, Limitations and Exclusions of the Policy to which it is attached, which are not in conflict with those of the Rider. For complete benefits and other provisions, please refer to the policy/certificate/rider. This coverage does not replace Workers’ Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. | This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and enforced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines. | Policy Form GHI17 Series | TX | Group Limited Benefit Hospital Indemnity Insurance Policy | (03/21) | FBS | Beaumont ISD

APSB-22507(TX)-0321 Beaumont ISD

Page 3 of 3

MDLIVE

Telehealth

About this Benefit Telehealth provides 24/7/365 access to boardcertified doctors via telephone consultations that can diagnose, recommend treatment and prescribe medication. Whether you are at home, traveling or at work, Telehealth makes care more convenient and accessible for non-emergency care when your primary care physician is not available.

YOUR BENEFITS PACKAGE

75%

of all doctor, urgent care, and ER visits could be handled safely and effectively via telehealth.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included This is a general overview of your plan benefits.inIfthe thesummary terms of plan this outline differlocated from your policy, the policy will govern. Additional plan description on the 26 details on covered expenses,Frisco limitations and exclusions included in the summary plan description located on the ISD Benefits Website:are www.mybenefitshub.com/friscoisd Beaumont ISD Benefits Website: www.mybenefitshub.com/beaumontisd

Telehealth Need a doctor?

Download the MDLIVE Mobile App

No long wait. No big bill. Always open. With MDLIVE, you can visit with a doctor 24/7 from your home, office or on-the-go.

Quality care now goes where you do. With MDLIVE, you can visit with a doctor or counselor 24/7 from your home, office or on-the-go.

Welcome to MDLIVE! Your anytime, anywhere doctor’s office.

Welcome to MDLIVE!

We treat over 50 routine medical conditions including:

Your virtual doctor is here. Join for free today!

• • • • • • •

The MDLIVE mobile app makes connecting with doctors and behavioral health counselors fast, easy and convenient.

Your anytime, anywhere doctor’s office. Avoid waiting rooms and the inconvenience of going to the Avoid waiting rooms and the inconvenience of going to the doctor’s office. Visit a doctor or counselor by phone, secure video doctor’s office. Visit a doctor by phone, secure video, or MDLIVE or MDLIVE app. Pediatricians are available 24/7, and family App. Pediatricians are available 24/7, and family members are also members are also eligible. eligible. • U.S. board-certified doctors with an average of 15 years of • U.S. board certified doctors and licensed counselors with an experience. average of 15 years of experience. • Consultations are convenient, private and secure. • Consultations are convenient, private and secure • Prescriptions can be sent to your nearest pharmacy, if • Prescriptions can be sent to your nearest pharmacy, if medically necessary. medically necessary.

Acne Allergies Cold / Flu Constipation Cough Diarrhea Ear Problems

• • • • • •

Fever Headache Insect Bites Nausea / Vomiting Pink Eye Rash

Your Monthly Premium is

• • • • •

Respiratory Problems Sore Throats Urinary Problems / UTI Vaginitis And More

No smartphone? No worries! Register your account using a computer or phone.

Download the app. Join for free. Visit a doctor. consultmdlive.com 888-365-1663

$10.00 Join for free. Visit a doctor. consulmdlive.com 888-365-1663

Copyright © 2019 MDLIVE Inc. All Rights Reserved. MDLIVE may not be available in certain states and is subject to state regulations. MDLIVE does not replace the primary care physician, is not an insurance product and may not be able to substitute for traditional in person care in every case or for every condition. MDLIVE does not prescribe DEA controlled substances and may not prescribe non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. MDLIVE does not guarantee patients will receive a prescription. Healthcare professionals using the platform have the right to deny care if based on professional judgment a case is inappropriate for telehealth or for misuse of services. MDLIVE and the MDLIVE logo are registered trademarks of MDLIVE, Inc. and may not be used without written permission. For complete terms of use visit https://www.MDLIVE.com/terms-of-use/.

METLIFE

Dental

YOUR BENEFITS PACKAGE

About this Benefit Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, treatment and dental disease.

Good dental care may improve your overall health. Also Women with gum disease may be at greater risk of giving birth to a preterm or low birth weight baby.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included This is a general overview of your plan benefits.inIfthe thesummary terms of plan this outline differlocated from your policy, the policy will govern. Additional plan description on the 28 details on covered expenses,Frisco limitations and exclusions included in the summary plan description located on the ISD Benefits Website:are www.mybenefitshub.com/friscoisd Beaumont ISD Benefits Website: www.mybenefitshub.com/beaumontisd

Dental - PPO - Low Plan Plan Summary

Network: PDP Plus

PLAN OPTION 1 Low Plan Coverage Type

In-Network % of Negotiated Fee*

Out-of-Network 90% of R&C Fee**

Type A: Preventive (cleanings, exams, X-rays) Type B: Basic Restorative (fillings, extractions) Type C: Major Restorative (bridges, dentures) Type D: Orthodontia

100% 70% 50% 50%

Individual Family

$50 $150

$750

$1,000

Deductible†

Annual Maximum Benefit Per Person

Orthodontia Lifetime Maximum Per Person

Child(ren)’s eligibility for dental coverage is from birth up to age 26, regardless of student status. Orthodontia coverage for dependent children up to age 19. *Negotiated Fee refers to the fees that participating dentists have agreed to accept as payment in full for covered services, subject to any copayments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change. ***R&C fee refers to the Reasonable and Customary (R&C) charge, which is based on the lowest of (1) the dentist’s actual charge, (2) the dentist’s usual charge for the same or similar services, or (3) the charge of most dentists in the same geographic area for the same or similar services as determined by MetLife. † Applies only to Type B & C Services.

List of Primary Covered Services & Limitations The service categories and plan limitations shown represent an overview of your Plan Benefits. This document presents the majority of services within each category, but is not a complete description of the Plan.

TYPE A—Preventive

How Many/How Often:

Prophylaxis (cleanings) Oral Examinations Topical Fluoride Applications

Two per calendar year Two exams per calendar year One fluoride treatment per year for dependent children up to his/her 19th birthday • Full mouth X-rays; one per 36 months • Bitewing X-rays; two set per calendar year One per tooth per lifetime for a child under age 14 One application of sealant material every 3 years for each non-restored, nondecayed 1st and 2nd molar of a dependent child up to his/her 14th birthday

X-rays Space Maintainers Sealants

TYPE B—Basic Restorative

How Many/How Often:

Fillings Simple Extractions Oral Surgery General Anesthesia

Replacement once every 24 months

TYPE C—Major Restorative

How Many/How Often:

When dentally necessary in connection with oral surgery, extractions or other covered dental services

Crown, Denture and Bridge Repair/ Recementations Bridges and Dentures Crowns, Inlays and Onlays Endodontics Periodontics

Repair once in 12 months period and Recementaions once in 12 months period Initial placement to replace one or more natural teeth, which are lost while covered by the plan Dentures and bridgework replacement; one every 10 years • Replacement of an existing temporary full denture if the temporary denture cannot be repaired and the permanent denture is installed within 12 months after the temporary denture was installed Replacement one every 10 years Root canal treatment limited to once per tooth per life time • Periodontal scaling and root planning once per quadrant, every 24 months • Periodontal surgery once per quadrant, every 36 months period • Total number of periodontal maintenance treatments and prophylaxis cannot exceed two treatments in a calendar year

•

TYPE D—Orthodontia

How Many/How Often:

• • • • •

Your children, up to age 19, are covered while Dental insurance is in effect. All dental procedures performed in connection with orthodontic treatment are payable as Orthodontia Payments are on a repetitive basis 20% of the Orthodontia Lifetime Maximum will be considered at initial placement of the appliance and paid based on the plan benefit’s coinsurance level for Orthodontia as defined in the plan summary Orthodontic benefits end at cancellation of coverage

The service categories and plan limitations shown above represent an overview of your plan benefits. This document presents the majority of services within each category, but is not a complete description of the plan.

Monthly Cost The following monthly costs are effective through August 31, 2021. Your premium will be paid through convenient payroll deduction. The Monthly costs shown below for “Employee + Spouse + Child(ren)” and “Employee + Family” include the cost for all eligible children.

Low Plan

Employee $24.44

Employee & Spouse $47.66

Employee & Child(ren) $53.80

Employee & Family $75.76 29

Dental - PPO - High Plan Plan Summary

Network: PDP Plus

PLAN OPTION 2 High Plan Coverage Type:

In-Network % of Negotiated Fee*

Out-of-Network 90% of R&C Fee***

Type A: Preventive (cleanings, exams, X-rays) Type B: Basic Restorative (fillings, extractions) Type C: Major Restorative (bridges, dentures) Type D: Orthodontia

100% 80% 50% 50%

Individual Family

$50 $150

$1,250

$1,500

Deductible†

Annual Maximum Benefit Per Person

Orthodontia Lifetime Maximum Per Person

TYPE A—Preventive

How Many/How Often:

Prophylaxis (cleanings) Oral Examinations Topical Fluoride Applications

Two per calendar year Two exams per calendar year One fluoride treatment per year for dependent children up to his/her 19th birthday • Full mouth X-rays; one per 36 months • Bitewing X-rays; two set per calendar year One per tooth lifetime for a child under age 14 One application of sealant material every 3 years for each non-restored, nondecayed 1st and 2nd molar of a dependent child up to his/her 14th birthday

X-rays Space Maintainers Sealants

TYPE B—Basic Restorative

How Many/How Often:

Fillings Simple Extractions Oral Surgery General Anesthesia

Replacement once every 24 months

TYPE C—Major Restorative

How Many/How Often:

When dentally necessary in connection with oral surgery, extractions or other covered dental services

Crown, Denture and Bridge Repair/ Recementations Bridges and Dentures Crowns, Inlays and Onlays Endodontics Periodontics

TYPE D—Orthodontia

Repair once in 12 months period and Recementaions once in 12 months period Initial placement to replace one or more natural teeth, which are lost while covered by the plan Dentures and bridgework replacement; one every 10 years • Replacement of an existing temporary full denture if the temporary denture cannot be repaired and the permanent denture is installed within 12 months after the temporary denture was installed Replacement one every 10 years Root canal treatment limited to once per tooth per life time • Periodontal scaling and root planning once per quadrant, every 24 months Periodontal surgery once per quadrant, every 36 months period • Total number of periodontal maintenance treatments and prophylaxis cannot exceed two treatments in a calendar year

•

• •

How Many/How Often:

You, your spouse and your children, up to age 19, are covered while Dental insurance is in effect All dental procedures performed in connection with orthodontic treatment are payable as Orthodontia • Payments are on a repetitive basis • 20% of the Orthodontia Lifetime Maximum will be considered at initial placement of the appliance and paid based on the plan benefit’s coinsurance level for Orthodontia as defined in the plan summary • Orthodontic benefits end at cancellation of coverage The service categories and plan limitations shown above represent an overview of your plan benefits. This document presents the majority of services within each category, but is not a complete description of the plan.

High Plan 30

Employee $29.15

Employee & Spouse $56.90

Employee & Child(ren) $64.14

Employee & Family $90.39

Frequently Asked Questions Who is a participating dentist? A participating dentist is a general dentist or specialist who has agreed to accept negotiated fees as payment in full for covered services provided to plan members. Negotiated fees typically range from 30%-45% below the average fees charged in a dentist’s community for the same or substantially similar services.† How do I find a participating dentist? There are thousands of general dentists and specialists to choose from nationwide --so you are sure to find one that meets your needs. You can receive a list of these participating dentists online at www.metlife.com/mybenefits or call 1-800-438-6388 to have a list faxed or mailed to you. What services are covered under this plan? The certificate of insurance/summary plan description sets forth the covered services under the plan. Please review the enclosed plan benefits to learn more.

May I choose a non-participating dentist? Yes. You are always free to select the dentist of your choice. However, if you choose a non-participating dentist your out-of-pocket costs may be higher. Can my dentist apply for participation in the network? Yes. If your current dentist does not participate in the network and you would like to encourage him/her to apply, ask your dentist to visit www.metdental.com, or call 1-866-PDP-NTWK for an application.†† The website and phone number are for use by dental professionals only. How are claims processed? Dentists may submit your claims for you which means you have little or no paperwork. You can track your claims online and even receive email alerts when a claim has been processed. If you need a claim form, visit www.metlife.com/mybenefits or request one by calling 1-800438-6388. Can I get an estimate of what my out-of-pocket expenses will be before receiving a service? Yes. You can ask for a pretreatment estimate. Your general dentist or specialist usually sends MetLife a plan for your care and requests an estimate of benefits. The estimate helps you prepare for the cost of dental services. We recommend that you request a pre-treatment estimate for services in excess of $200. Simply have your dentist submit a request online at www.metdental.com or call 1-877-MET-DDS9. You and your dentist will receive a benefit estimate for most procedures while you are still in the office. Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment. Can MetLife help me find a dentist outside of the U.S. if I am traveling? Yes. Through international dental travel assistance services* you can obtain a referral to a local dentist by calling +1-312-356-5970 (collect) when outside the U.S. to receive immediate care until you can see your dentist. Coverage will be considered under your out-of-network benefits.** Please remember to hold on to all receipts to submit a dental claim. How does MetLife coordinate benefits with other insurance plans? Coordination of benefits provisions in dental benefits plans are a set of rules that are followed when a patient is covered by more than one dental benefits plan. These rules determine the order in which the plans will pay benefits. If the MetLife dental benefit plan is primary, MetLife will pay the full amount of benefits that would normally be available under the plan, subject to applicable law. If the MetLife dental benefit plan is secondary, most coordination of benefits provisions require MetLife to determine benefits after benefits have been determined under the primary plan. The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan, subject to applicable law. Do I need an ID card? No. You do not need to present an ID card to confirm that you are eligible. You should notify your dentist that you are enrolled in the MetLife Preferred Dentist Program. Your dentist can easily verify information about your coverage through a toll-free automated Computer Voice Response system.

†Based on internal analysis by MetLife. Negotiated fees refer to the fees that in-network dentists have agreed to accept as payment in full for covered services, subject to any co-payments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change. ††Due to contractual requirements, MetLife is prevented from soliciting certain providers. * AXA Assistance USA, Inc. provides Dental referral services only. AXA Assistance is not affiliated with MetLife, and the services and benefits they provide are separate and apart from the insurance provided by MetLife. Referral services are not available in all locations. **Refer to your dental benefits plan summary for your out-of-network dental coverage. 31

Exclusions This plan does not cover the following services, treatments and supplies:

•

Services which are not Dentally Necessary, those which do not meet generally accepted standards of care for treating the particular dental condition, or which we deem experimental in nature;

•

Dental services arising out of accidental injury to the teeth and supporting structures, except for injuries to the teeth due to chewing or biting of food;

• •

Caries susceptibility tests;

•

Other fixed Denture prosthetic services not described elsewhere in the certificate;

•

Precision attachments, except when the precision attachment is related to implant prosthetics;

•

Services for which you would not be required to pay in the absence of Dental Insurance;

•

Services or supplies received by you or your Dependent before the Dental Insurance starts for that person;

•

Services which are primarily cosmetic (for Texas residents, see notice page section in Certificate);

•

Services which are neither performed nor prescribed by a Dentist except for those services of a licensed dental • hygienist which are supervised and billed by a Dentist and which are for:  Scaling and polishing of teeth; or  Fluoride treatments; Services or appliances which restore or alter occlusion or vertical • dimension;

• •

Restoration of tooth structure damaged by attrition, abrasion or erosion;

•

Restorations or appliances used for the purpose of periodontal splinting;

•

Counseling or instruction about oral hygiene, plaque control, nutrition and tobacco;

•

Personal supplies or devices including, but not limited to: water picks, toothbrushes, or dental floss;

•

Decoration, personalization or inscription of any tooth, device, appliance, crown or other dental work;

• •

Missed appointments;

• • • • • •

Services:  Covered under any workers’ compensation or occupational disease law;  Covered under any employer liability law;  For which the employer of the person receiving such services is not required to pay; or  Received at a facility maintained by the Employer, labor union, mutual benefit association, or VA hospital; Services covered under other coverage provided by the Employer; Temporary or provisional restorations; Temporary or provisional appliances; Prescription drugs; Services for which the submitted documentation indicates a poor prognosis; The following when charged by the Dentist on a separate basis:  Claim form completion;  Infection control such as gloves, masks, and sterilization of supplies; or  Local anesthesia, non-intravenous conscious sedation or analgesia such as nitrous oxide.

Initial installation of a fixed and permanent Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth;

Initial installation of a full or removable Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth; Addition of teeth to a partial removable Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth;

•

Adjustment of a Denture made within 6 months after installation by the same Dentist who installed it;

•

Implants including, but not limited to any related surgery, placement, restorations, maintenance, and removal;

• •

Repair of implants;

• •

Fixed and removable appliances for correction of harmful habits;

•

Diagnosis and treatment of temporomandibular joint (TMJ) disorders. This exclusion does not apply to residents of Minnesota;

• • •

Repair or replacement of an orthodontic device;

•

Intra and extraoral photographic images

Implants supported prosthetics to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth; Appliances or treatment for bruxism (grinding teeth), including but not limited to occlusal guards and night guards;

Duplicate prosthetic devices or appliances; Replacement of a lost or stolen appliance, Cast Restoration, or Denture; and

Limitations Alternate Benefits: Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. If you and your dentist have agreed on a treatment that is more costly than the treatment upon which the plan benefit is based, you will be responsible for any additional payment responsibility. To avoid any misunderstandings, we suggest you discuss treatment options with your dentist before services are rendered, and obtain a pre-treatment estimate of benefits prior to receiving certain high cost services such as crowns, bridges or dentures. You and your dentist will each receive an Explanation of Benefits (EOB) outlining the services provided, your plan’s reimbursement for those services, and your out-of-pocket expense. Procedure charge schedules are subject to change each plan year. You can obtain an updated procedure charge schedule for your area via fax by calling 1-800 -942-0854 and using the MetLife Dental Automated Information Service. Actual payments may vary from the pretreatment estimate depending upon annual maximums, plan frequency limits, deductibles and other limits applicable at time of payment. Cancellation/Termination of Benefits: Coverage is provided under a group insurance policy (Policy form GPNP99) issued by Metropolitan Life Insurance Company (MetLife). Coverage terminates when your membership ceases, when your dental contributions cease or upon termination of the group policy by the Policyholder or MetLife. The group policy terminates for non-payment of premium and may terminate if participation requirements are not met or if the Policyholder fails to perform any obligations under the policy. The following services that are in progress while coverage is in effect will be paid after the coverage ends, if the applicable installment or the treatment is finished within 3 months after individual termination of coverage: Completion of a prosthetic device, crown or root canal therapy. Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods and terms for keeping them in force. For complete details of coverage and availability, please refer to the certificate of insurance or contact MetLife. Metropolitan Life Insurance Company | 200 Park Avenue | New York, NY 10166 L0319512645[exp0520][xNM] © 2019 MetLife Services and Solutions, LLC DN-ANY-PPO-DUAL

UNITEDHEALTHCARE

Vision

YOUR BENEFITS PACKAGE

About this Benefit Vision insurance provides coverage for routine eye examinations and may cover all or part of the costs associated with contact lenses, eyeglasses and vision correction, depending on the plan.

75% of U.S. residents between age 25 and 64 require some sort of vision correction.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan details on covered expenses, limitations and exclusions are included This is a general overview of your plan benefits.inIfthe thesummary terms of plan this outline differlocated from your policy, the policy will govern. Additional plan description on the 34 details on covered expenses,Frisco limitations and exclusions included in the summary plan description located on the ISD Benefits Website:are www.mybenefitshub.com/friscoisd Beaumont ISD Benefits Website: www.mybenefitshub.com/beaumontisd

Vision Benefit Summary UnitedHealthcare vision has been trusted for more than 50 years to deliver affordable, innovative vision care solutions to the nation’s leading employers through experienced, customer-focused people and the nation’s most accessible, diversified vision care network. In-network, covered -in-full benefits (up to the plan allowance and after applicable copay) include a comprehensive exam, eyeglasses with standard single vision, lined bifocal, lined trifocal, or lenticular lenses, standard scratch-resistant coating¹ and the frame, or contact lenses in lieu of eyeglasses.

Rates(Monthly)

Exam with Materials

Employee Employee + Spouse Employee + Child(ren) Employee + Family

$7.74 $14.68 $17.22 $24.24 Benefit Frequency

Comprehensive Exam(s) Spectacle Lenses Frames Contact Lenses in Lieu of Eyeglasses

Once every 12 months Once every 12 months Once every 12 months Once every 12 months

In-NetworkServices Copays Exam(s) Materials

$ 10.00 $ 25.00 Frame Benefit (for frames that exceed the allowance, an additional 30% discount may be applied to the overage)² Private Practice Provider $150.00 retail frame allowance Retail Chain Provider $150.00 retail frame allowance Lens Options Standard scratch-resistant coating, Polycarbonate Lenses for Dependents -- covered in full. Other optional lens upgrades may be offered at a discount. (Discount varies by provider.) Contact Lens Benefit³ (Selection contact lenses refers to our formulary contact list. Contact lenses not listed on the formulary are referred to as nonselection. A copy of the list can be found at myuhcvision.com) Selection contact lenses The fitting/evaluation fees, contact lenses, and up to two follow- If you choose disposable contacts, up to 6 boxes are up visits are covered in full after copay (if applicable). included when obtained from an in-network provider. Non-selection contact lenses An allowance is applied toward the purchase of contact $150.00 lenses outside the selection. Materials copay (if applicable) is waived. Necessary contact lenses4 Covered in full after copay (if applicable).

Out-of-Network Reimbursements (Copays do not apply) Exam(s) Frames Single Vision Lenses Lined Bifocal Lenses Lined Trifocal Lenses Lenticular Lenses Elective Contacts in Lieu of Eyeglasses³ Necessary Contacts in Lieu of Eyeglasses4

Up to$40.00 Up to$45.00 Up to$40.00 Up to$60.00 Up to$80.00 Up to$80.00 Up to $150.00 Up to $210.00

Laser Vision Benefit Laser vision—UnitedHealthcare has partnered with the Laser Vision Network of America (LVNA) to provide our members with access to discounted laser vision correction providers. Members receive 15% off standard or 5% off promotional pricing at more than 550 network provider locations and even greater discounts through set pricing at LasikPlus® locations. For more information, call 1-888-563-4497 or visit us atwww.uhclasik.com. AdditionalMaterial—At a participating in-network provider you will receive up to a 20% discount on an additional pair of eyeglasses or contact lenses. This program is available after your vision benefits have been exhausted. Please note that this discount shall not be considered insurance, and that UnitedHealthcare shall neither pay nor reimburse the provider or member for any funds owed or spent. Additional materials do not have to be purchased at the time of initial material purchase. Hearing Aids—As a UnitedHealthcare vision plan member, you can save on high-quality hearing aids when you buy them from hi HealthInnovations™. To find out more go to hiHealthInnovations.com. When placing your order use promo code myVision to get the special price discount. 35

Vision Sample Illustration of Savings Cost

Employee Only

Employee + Spouse

Employee + Child(ren)

Employee + Family

Monthly Premium

$7.74

$14.68

$17.22

$24.24

Annual Premium

$92.88

$176.16

$206.64

$291.12

Approx. Pre-Tax Savings (20%)5

$18.58

$35.23

$41.33

$58.22

Annual Tax-Adjusted Premium

$74.30

$140.93

$165.31

$232.90

Plus Copays

$35.00

$70.00

$105.00

$140.00

Total Cost to Employee

$109.30

$210.93

$270.31

$372.90

Exam and Materials Covered by UnitedHealthcare Vision Plan

Estimated Cost Without a Vision Plan6

Less Employee Cost

Total Savings with UnitedHealthcareVision

Employee Only Exam, Single Vision & Covered-in-Full Frame

$275.00

$109.30

$165.70

Employee + Spouse Exam, Single Vision & Covered-in-Full Frame

$550.00

$210.93

$339.07

Employee + Child(ren)7 Exam, Single Vision & Covered-in-Full Frame

$825.00

$270.31

$554.69

Employee + Family8 Exam, Single Vision & Covered-in-Full Frame

$1,100.00

$372.90

$727.10

¹On all orders processed through a company owned and contracted lab network. ²30% discount available at most participating in-network provider locations. May exclude certain frame manufacturers. Please verify all discounts with your provider. ³Contact lenses are in lieu of eyeglass lenses and/or eyeglass frames. Coverage for Selection contact lenses does not apply at Costco, Walmart or Sam's Club locations. The allowance for Non-selection contact lenses applies to materials. No portion will be exclusively applied to the fitting and evaluation. 4Necessary contact lenses are determined at the provider's discretion for one or more of the following conditions: Following cataract surgery without intraocular lens implant; to correct extreme vision problems that cannot be corrected with eyeglass lenses and/or frames; with certain conditions such as anisometropia, keratoconus, irregular corneal/astigmatism, aphakia, facial deformity; or corneal deformity. If your provider considers your contacts necessary, you should ask your provider to contact UnitedHealthcare vision confirming the reimbursement that UnitedHealthcare will make before you purchase such contacts. 5 Actual tax savings will depend upon your individual tax bracket. 6Approximate retail value illustrated: Exam & Refraction ($65), Single Vision Lenses ($80), and Frames ($130). Average retail cost may vary by provider. 7 For purposes of this calculation, Employee + Child(ren) is calculated with three (3) members. 8 For purposes of this sample calculation, Employee + Family is calculated with four (4) members.

Important to Remember In-Network • Always identify yourself as a UnitedHealthcare vision member when making your appointment. This will assist the provider in obtaining your benefit information. • Your participating provider will help you determine which contact lenses are available in the UnitedHealthcare selection. • Your $150.00 contact lens allowance applies to materials. No portion will be exclusively applied to the fitting and evaluation. Your material copay is waived when purchasing non-selection contacts. • Patient options such as UV coating, progressive lenses, etc., which are not covered-in-full, may be available at a discount at participating providers. Choice and Access of Vision Care Providers UnitedHealthcare offers its vision program through a national network including both private practice and retail chain providers. To access the Provider Locator service, visit our website myuhcvision.com or call (800) 638-3120, 24 hours a day, seven days a week. You may also view your benefits, search for a provider or print an ID card online at myuhcvision.com. Retain this UnitedHealthcare vision benefit summary which includes detailed benefit information and instructions on how to use the program. Please refer to your Certificate of Coverage for a full explanation of benefits. In-Network Provider - Copays and non-covered patient options are paid to provider by program participant at the time of service. Out-of-Network Provider - Participant pays full fee to the provider, and UnitedHealthcare reimburses the participant for services rendered up to the maximum allowance. Copays do not apply to out-of-network benefits. All receipts must be submitted at the same time to the following address: UnitedHealthcare Vision, Attn. Claims Department, P.O. Box 30978, Salt Lake City, UT 84130. Written proof of loss should be given to the Company within 90 days after the date of loss. If it was not reasonably possible to give written proof in the time required, the Company will not reduce or deny the claim for this reason. However, proof must be filed as soon as reasonably possible, but no later than 1 year after the date of service unless the Covered Person was legally incapacitated. 36

Vision Customer Service is available toll-free at (800) 638-3120 from 8:00 a.m. to 11:00 p.m. Eastern Time Monday through Friday, and 9:00 a.m. to 6:30 p.m. Eastern Time on Saturday. This Benefit Summary is intended only to highlight your benefits and should not be relied upon to fully determine coverage. This benefit plan may not cover all of your healthcare expenses. More complete descriptions of benefits and the terms under which they are provided are contained in the certificate of coverage that you will receive upon enrolling in the plan. If this Benefit Summary conflicts in any way with the Policy issued to your employer, the Policy shall prevail.

Customer Service and Provider Locator: (800) 638-3120 myuhcvision.com UnitedHealthcare vision has been trusted for more than 50 years to deliver affordable, innovative vision care solutions to the nation’s leading employers through experienced, customer-focused people and the nation’s most accessible, diversified vision care network. In-network, covered -in-full benefits (up to the plan allowance and after applicable copay) include a comprehensive exam, eyeglasses with standard single vision, lined bifocal, lined trifocal, or lenticular lenses, standard scratch-resistant coating¹ and the frame, or contact lenses in lieu of eyeglasses.

CIGNA YOUR BENEFITS PACKAGE

Long Term Disability

About this Benefit Disability insurance protects one of your most valuable assets, your paycheck. This insurance will replace a portion of your income in the event that you become physically unable to work due to sickness or injury for an extended period of time.

Just over 1 in 4 of today's 20 year -olds will become disabled before they retire.

34.6 months is the duration of the average disability claim.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 38 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Beaumont ISD Benefits Website: www.mybenefitshub.com/beaumontisd

Long Term Disability SUMMARY OF BENEFITS Prepared for: Beaumont ISD If you had an unexpected illness of injury and were unable to work, how long would you be able to pay your bills? Long-term disability pays a portion of you salary if you’re unable to work due to a covered disability.

months, you are considered disabled if solely due to your injury or sickness, you are unable to perform the material duties of any occupation for which you are (or may reasonably become) qualified by education, training or experience, and you are unable to earn 60% or more of your indexed earnings. We will require proof of earnings and continued disability.

Covered Earnings–“Covered Earnings” means your wages or

Eligibility: All active Full-time Employees of the Employer who are citizens or permanent resident aliens of the United States and working a minimum of 20 hours per week in the United States.

Employee Options: Gross Monthly Benefit1 Select Monthly Benefit: Flat dollar benefit in $100 increments between $200 and $7,500 that cannot exceed 662/3% of your current monthly earnings

Maximum Gross Monthly Benefit $7,500 Accident

Sickness

0 days

7 days

14 days

30 days

60 days

Benefit Waiting Period Options Select from Four Options:

Maximum Benefit Period Please refer to the “Maximum Benefit Period” Schedules below for more details

Employee's Monthly Cost of Coverage2: Use the attached rate sheets.

salary, not including bonuses, commissions, and other extra compensation.

When Benefits Begin–You must be continuously Disabled for your elected benefit waiting period before benefits will be payable for a covered Disability. For any selected Benefit Waiting Period of 30 days or less, the Benefit Waiting Period will end of the date you are admitted as an inpatient in a hospital if that date is before the end of the time period specified.

Maximum Benefit Period-Once you qualify for benefits under this plan, you continue to receive them until the end of the benefit or until you no longer qualify for benefits, whichever occurs first. Should you remain Disabled, your benefits continue according to one of the following schedules, depending on your age at the time you become Disabled and the plan you select. Age at Disability

Duration of Payments (Accident and Sickness)

Prior to age 63

To age SSNRA or the date the 48th monthly benefit is payable, if later

To age SSNRA or the date the 42nd monthly benefit is payable, if later

64 65 66 67 68 69+

36 30 27 24 21 18

Maximum Benefit Period Schedule When Coverage Takes Effect–Your coverage takes effect on

the later of the policy’s effective date, the date you become eligible, the date we receive your completed enrollment form, or the date you authorize any necessary payroll deductions. If Disability–“Disability” or “Disabled” means that, solely because you’re not actively at work on the date your coverage would otherwise take effect, your coverage will take effect on the date of a covered injury or sickness, you are unable to perform the material duties of your regular occupation and you are unable to you return to work. If you have to submit evidence of good earn 80% or more of your indexed earnings from working in your health, your coverage takes effect on the date we agree, in writing, to cover you. regular occupation. After benefits have been payable for 24

Important Definitions and Policy Provisions:

1 Your benefit amount will be reduced by any amounts payable to you by any of the sources listed under the “Effects of Other Income Benefits” section. 39

Long Term Disability Benefit Reductions, Conditions, Limitations and Exclusions: Effects of Other Income Benefits- This plan is structured to prevent your total benefits and post-disability earnings from equaling or exceeding pre-disability earnings. Therefore, we reduce this plan’s benefits by Other Income Benefits payable to you, your dependents, or a qualified third party on behalf of you or your dependents. Disability benefits will be reduced by amounts received through Social Security disability benefits payable to you, your dependents, or a qualified third party on behalf of you or your dependents. Your disability benefits will not be reduced by any Social Security disability benefits you are not receiving as long as you cooperate fully in efforts to obtain them and agree to repay any overpayment when and if you do receive them. Disability benefits will also be reduced by amounts received through other government programs, employer’s sabbatical leave, employer’s assault leave plan, employer funded retirement benefits, workers’ compensation, franchise/group insurance, auto no-fault, and damages for wage loss. For details, see your outline of coverage, policy certificate, or your employer’s summary plan description. Note: Some of the Other Income Benefits, as defined in the group policy, will not be considered until after disability benefits are payable for 6 months

Earnings While Disabled–During the first 24 months that benefits are payable, benefits will be reduced if benefits plus income from employment exceeds 100% of pre-disability Covered Earnings. After that, benefits will be reduced by 50% of earnings from employment.

Limited Benefit Period–Disabilities caused by or contributed to by any one or more of the following conditions are subject to a lifetime limit of 24 months for outpatient treatment: Anxiety-disorders, delusional (paranoid) or depressive disorders, eating disorders, mental illness, somatoform disorders (including psychosomatic illnesses) ,alcoholism, drug addiction or abuse. Benefits are payable during periods of hospital confinement for these conditions for hospitalizations lasting more than 14 consecutive days that occur before the 24-month lifetime outpatient limit is exhausted. Pre-existing Condition Limitation-Benefits are not payable for medical conditions for which you incurred expenses, took prescription drugs, received medical treatment, care or services (including diagnostic measures,) during the 3 months just prior to the most recent effective date of insurance. Benefits are not payable for any disability resulting from a pre -existing condition unless the disability occurs after you have been insured under this plan for at least 12 months after your most recent effective date of insurance. 40

Termination of Disability Benefits–Your benefits will terminate when your Disability ceases, when your benefit duration period is exceeded, or on the following events: (1) the date you earn from any occupation more than 80% of your Covered Earnings, or the date you fail to cooperate with us in a rehabilitation plan, or transitional work arrangement, or the administration of the claim.

Rehabilitation Requirement–To be eligible for Disability benefits under this plan, you may be required to participate in a rehabilitation plan at the sole discretion and expense of the insurance company or company administering benefits under this plan. If you fail to fully cooperate with the rehabilitation plan, no Disability benefits will be paid, and coverage will end. For details, see your Certificate of Insurance. Exclusions–This plan does not pay benefits for a Disability which results, directly or indirectly, from any of the following: • Suicide, attempted suicide, or intentionally self-inflicted injury while sane or insane. ─ war or any act of war, whether or not declared. ─ active participation in a riot; • commission of a felony; • the revocation, restriction or non-renewal of an Employee’s license, permit or certification necessary to perform the duties of his or her occupation unless due solely to Injury or Sickness otherwise covered by the Policy. ─ any cosmetic surgery or surgical procedure that is not Medically Necessary. ─ an Injury or Sickness for which the Employee is entitled to benefits from Workers’ Compensation or occupational disease law. ─ an Injury or Sickness that is work related. In addition, the plan does not pay disability benefits any period of Disability during which you are incarcerated in a penal or corrections institution. 1 Your benefit amount will be reduced by any amounts payable to you by any of the sources listed under the “Effects of Other Income Benefits” section. 2 Costs are subject to change. Terms and conditions of coverage for Long-Term Disability insurance are set forth in Group Policy No. VDT-XXXX. This is not intended as a complete description of the insurance coverage offered. This is not a contract. Complete coverage details, including premiums, are contained in the Policy Certificate. If there are any differences between this summary and the group policy, the information in the group policy takes precedence. Product availability and/or features may vary by state. Please keep this material as a reference. Insurance coverage is issued on group policy form number: Policy Form TL-004700. Coverage is underwritten by Life Insurance Company of North America, 1601 Chestnut St. Philadelphia, PA 19192. “Cigna” and the “Tree of Life” logo are registered service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries, including Life Insurance Company of North America and Cigna Life Insurance Company of NewYork, and not by Cigna Corporation. 882862 04/15 © 2018 Cigna. Some content provided under license.

Long Term Disability Rates are subject to change; Age Band changes occur at plan anniversary Max. Benefit %

66.67%

Option 1

Option 2

Option 3

Option 4

Elimination Period: Injury (Days) Sickness (Days) Maximum Gross Annual Salary Monthly Benefit $1,800 $100

Monthly Cost $6.00

$4.30

$3.44

$2.80

$3,600

$200

$12.00

$8.60

$6.88

$5.60

$5,400

$300

$18.00

$12.90

$10.32

$8.40

$7,200

$400

$24.00

$17.20

$13.76

$11.20

$9,000

$500

$30.00

$21.50

$17.20

$14.00

$10,800

$600

$36.00

$25.80

$20.64

$16.80

$12,600

$700

$42.00

$30.10

$24.08

$19.60

$14,400

$800

$48.00

$34.40

$27.52

$22.40

$16,200

$900

$54.00

$38.70

$30.96

$25.20

$18,000

$1,000

$60.00

$43.00

$34.40

$28.00

$19,800

$1,100

$66.00

$47.30

$37.84

$30.80

$21,600

$1,200

$72.00

$51.60

$41.28

$33.60

$23,400

$1,300

$78.00

$55.90

$44.72

$36.40

$25,200

$1,400

$84.00

$60.20

$48.16

$39.20

$27,000

$1,500

$90.00

$64.50

$51.60

$42.00

$28,800

$1,600

$96.00

$68.80

$55.04

$44.80

$30,600

$1,700

$102.00

$73.10

$58.48

$47.60

$32,400

$1,800

$108.00

$77.40

$61.92

$50.40

$34,200

$1,900

$114.00

$81.70

$65.36

$53.20

$36,000

$2,000

$120.00

$86.00

$68.80

$56.00

$37,800

$2,100

$126.00

$90.30

$72.24

$58.80

$39,600

$2,200

$132.00

$94.60

$75.68

$61.60

$41,400

$2,300

$138.00

$98.90

$79.12

$64.40

$43,200

$2,400

$144.00

$103.20

$82.56

$67.20

$45,000

$2,500

$150.00

$107.50

$86.00

$70.00

$46,800

$2,600

$156.00

$111.80

$89.44

$72.80

$48,600

$2,700

$162.00

$116.10

$92.88

$75.60

$50,400

$2,800

$168.00

$120.40

$96.32

$78.40

$52,200

$2,900

$174.00

$124.70

$99.76

$81.20

$54,000

$3,000

$180.00

$129.00

$103.20

$84.00

$55,800

$3,100

$186.00

$133.30

$106.64

$86.80

$57,600

$3,200

$192.00

$137.60

$110.08

$89.60

$59,400

$3,300

$198.00

$141.90

$113.52

$92.40

$61,200

$3,400

$204.00

$146.20

$116.96

$95.20

$63,000

$3,500

$210.00

$150.50

$120.40

$98.00

$64,800

$3,600

$216.00

$154.80

$123.84

$100.80

$66,600

$3,700

$222.00

$159.10

$127.28

$103.60 41

Long Term Disability Rates are subject to change; Age Band changes occur at plan anniversary Max. Benefit % 66.67% Option 1 Option 2 Option 3 Elimination Period: Injury (Days) 0 14 30 Sickness (Days) 7 14 30 Maximum Gross Annual Salary Monthly Cost Monthly Benefit $68,400 $3,800 $228.00 $163.40 $130.72 $70,200 $3,900 $234.00 $167.70 $134.16 $72,000 $4,000 $240.00 $172.00 $137.60 $73,800 $4,100 $246.00 $176.30 $141.04 $75,600 $4,200 $252.00 $180.60 $144.48 $77,400 $4,300 $258.00 $184.90 $147.92 $79,200 $4,400 $264.00 $189.20 $151.36 $81,000 $4,500 $270.00 $193.50 $154.80 $82,800 $4,600 $276.00 $197.80 $158.24 $84,600 $4,700 $282.00 $202.10 $161.68 $86,400 $4,800 $288.00 $206.40 $165.12 $88,200 $4,900 $294.00 $210.70 $168.56 $90,000 $5,000 $300.00 $215.00 $172.00 $91,800 $5,100 $306.00 $219.30 $175.44 $93,600 $5,200 $312.00 $223.60 $178.88 $95,400 $5,300 $318.00 $227.90 $182.32 $97,200 $5,400 $324.00 $232.20 $185.76 $99,000 $5,500 $330.00 $236.50 $189.20 $100,800 $5,600 $336.00 $240.80 $192.64 $102,600 $5,700 $342.00 $245.10 $196.08 $104,400 $5,800 $348.00 $249.40 $199.52 $106,200 $5,900 $354.00 $253.70 $202.96 $108,000 $6,000 $360.00 $258.00 $206.40 $109,800 $6,100 $366.00 $262.30 $209.84 $111,600 $6,200 $372.00 $266.60 $213.28 $113,400 $6,300 $378.00 $270.90 $216.72 $115,200 $6,400 $384.00 $275.20 $220.16 $117,000 $6,500 $390.00 $279.50 $223.60 $118,800 $6,600 $396.00 $283.80 $227.04 $120,600 $6,700 $402.00 $288.10 $230.48 $122,400 $6,800 $408.00 $292.40 $233.92 $124,200 $6,900 $414.00 $296.70 $237.36 $126,000 $7,000 $420.00 $301.00 $240.80 $127,800 $7,100 $426.00 $305.30 $244.24 $129,600 $7,200 $432.00 $309.60 $247.68 $131,400 $7,300 $438.00 $313.90 $251.12 $133,200 $7,400 $444.00 $318.20 $254.56 $135,000 $7,500 $450.00 $322.50 $258.00 $136,800 $7,600 $456.00 $326.80 $261.44 $138,600 $7,700 $462.00 $331.10 $264.88 $140,400 $7,800 $468.00 $335.40 $268.32 $142,200 $7,900 $474.00 $339.70 $271.76 $144,000 $8,000 $480.00 $344.00 $275.20

Option 4 60 60

$106.40 $109.20 $112.00 $114.80 $117.60 $120.40 $123.20 $126.00 $128.80 $131.60 $134.40 $137.20 $140.00 $142.80 $145.60 $148.40 $151.20 $154.00 $156.80 $159.60 $162.40 $165.20 $168.00 $170.80 $173.60 $176.40 $179.20 $182.00 $184.80 $187.60 $190.40 $193.20 $196.00 $198.80 $201.60 $204.40 $207.20 $210.00 $212.80 $215.60 $218.40 $221.20 $224.00

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Life Insurance Company of North America. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. 42

APL

Cancer

About this Benefit Cancer insurance offers you and your family supplemental insurance protection in the event you or a covered family member is diagnosed with cancer. It pays a benefit directly to you to help with expenses associated with cancer treatment.

YOUR BENEFITS PACKAGE

Breast Cancer is the most commonly diagnosed cancer in women.

If caught early, prostate cancer is one of the most treatable malignancies.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 44 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Beaumont ISD Benefits Website: www.mybenefitshub.com/beaumontisd

GC14 Limited Benefit Group Cancer Indemnity Insurance Beaumont ISD THE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM BY PURCHASING THE POLICY AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYEE LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS’ COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS’ COMPENSATION LAW AS IT PERTAINS TO NONSUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED.

SUMMARY OF BENEFITS

Option 1

Option 2

Cancer Treatment Policy Benefits

Level 1

Radiation Therapy, Chemotherapy, Immunotherapy - Maximum per 12-month period

$10,000

$50 per treatment

Hormone Therapy - Maximum of 12 treatments per calendar year Experimental Treatment Cancer Screening Rider Benefits Diagnostic Testing - 1 test per calendar year Follow-Up Diagnostic Testing - 1 test per calendar year Medical Imaging - per calendar year Surgical Rider Benefits Surgical Anesthesia Bone Marrow Transplant - Maximum per lifetime Stem Cell Transplant - Maximum per lifetime Prosthesis - Surgical Implantation/Non-Surgical (not Hair Piece) 1 device per site, per lifetime Patient Care Rider Benefits Hospital Confinement Per day of Hospital Confinement (1-30 days) Per day for Eligible Dependent Children (1-30 days) Per day of Hospital Confinement (31+ days) Per day for Eligible Dependent Children (31+ days) Outpatient Facility - Per day surgery is performed Attending Physician - Per day of Hospital Confinement Dread Disease - Per day of Hospital Confinement (1-30 days / 31+ days)

paid in same manner and under the same maximums as any other benefit Level 1 Level 1 $50 per test

$50 per test

$100 per test

$500 per test / 1 per calendar year Level 1

$30 unit dollar amount Max $3,000 per operation

25% of amount paid for covered surgery $6,000

$6,000

$600

$1,000 / $100

Level 1

$100 $200 $100 $200 $200

$30

$100 / $100

Extended Care Facility - Up to the same number of Hospital Confinement Days

$100 per day

Donor

$100 per day

Home Health Care - Up to the same number of Hospital Confinement Days

$100 per day

Hospice Care - Up to maximum of 365 days per lifetime

$100 per day

US Government, Charity Hospital or HMO Per day of Hospital Confinement (1-30 days / 31+ days) Miscellaneous Care Rider Benefits

$100 / $100 Level 1

Cancer Treatment Center Evaluation or Consultation - 1 per lifetime

Not Included

Evaluation or Consultation Travel and Lodging - 1 per lifetime

Not Included

Second / Third Surgical Opinion - per diagnosis of cancer

$300 / $300

$150 per confinement $50 per prescription $150

actual coach fare or $.40 per mile $.40 per mile $50 per day actual coach fare or $.40 per mile $.40 per mile $50 per day

Drugs and Medicine - Inpatient / Outpatient (maximum $150 per month) Hair Piece (Wig) - 1 per lifetime Transportation - Maximum 12 trips per calendar year for all modes of transportation combined Travel by bus, plane or train Travel by car Lodging - up to a maximum of 100 days per calendar year Family Transportation - Maximum 12 trips per calendar year for all modes of transportation combined Travel by bus, plane or train Travel by car Family Lodging - up to a maximum of 100 days per calendar year

APSB-22339(TX)-0615 MGM/FBS Beaumont ISD

GC14 Limited Benefit Group Cancer Indemnity Insurance Option 1

Option 2

$300 per day

$200 / $2,000 per trip $150 per day

Outpatient Special Nursing Services - Up to same number of Hospital Confinement days

$150 per day

Medical Equipment - Maximum of 1 benefit per calendar year

Not Included

$25 per visit / $1,000

Waive Premium

Internal Cancer First Occurrence Rider Benefits

Level 1

Level 2

Lump Sum Benefit - Maximum 1 per Covered Person per lifetime

$2,500

$5,000

Lump Sum for Eligible Dependent Children - Maximum 1 per Covered Person per lifetime

$3,750

$7,500

Intensive Care Unit

$600 per day

Step Down Unit - Maximum of 45 days per Confinement for any combination of Intensive Care Unit or Step Down Unit

$300 per day

Miscellaneous Care Rider Benefits Con’t. Blood, Plasma and Platelets Ambulance - Ground/Air - Maximum of 2 trips per Hospital Confinement for all modes of transportation combined Inpatient Special Nursing Services - per day of Hospital Confinement

Physical, Occupational, Speech, Audio Therapy & Psychotherapy / Maximum per calendar year Waiver of Premium

Hospital Intensive Care Unit Rider Benefits

TOTAL MONTHLY PREMIUMS BY PLAN** Issue Ages 18+

Individual

Individual & Spouse

1 Parent Family

2 Parent Family

Option 1

Option 2

Option 1

Option 2

Option 1

Option 2

Option 1

Option 2

$19.80

$22.70

$41.70

$48.00

$25.78

$29.14

$47.62

$54.40

**Total premium includes the Plan selected and any applicable rider premium. Premiums are subject to increase with notice. The premium and amount of benefits vary dependent upon the Plan selected at time of application.

Benefits are only payable following a diagnosis of cancer for a loss incurred for the treatment of cancer while covered under the policy. A charge must be incurred for benefits to be payable. When coverage terminates for loss incurred after the coverage termination date, our obligation to pay benefits also terminates for a specified disease that manifested itself while the person was covered under the policy. All benefits are subject to the benefit maximums.

Pre-Existing Condition Exclusion

Cancer Treatment Benefits

No benefits are payable for any loss incurred during the pre-existing condition exclusion period, following the covered person’s effective date as the result of a pre-existing condition. Pre-existing conditions specifically named or described as excluded in any part of the policy are never covered. If any change to coverage after the certificate effective date results in an increase or addition to coverage, the time limit on certain defenses and pre-existing condition exclusion for such increase will be based on the effective date of such increase.

Eligibility

Waiting Period

You and your eligible dependents are eligible to be insured under this certificate if you and your eligible dependents meet our underwriting rules and you are actively at work with the policyholder and qualify for coverage as defined in the master application.

Limitations and Exclusions

No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; or losses or medical expenses incurred prior to the covered person’s effective date regardless of when specified disease was diagnosed.

Only Loss for Cancer

The policy pays only for loss resulting from definitive cancer treatment including direct extension, metastatic spread or recurrence. Proof must be submitted to support each claim. The policy also covers other conditions or diseases directly caused by cancer or the treatment of cancer. The policy does not cover any other disease, sickness or incapacity which existed prior to the diagnosis of cancer, even though after contracting cancer it may have been complicated, aggravated or affected by cancer or the treatment of cancer. 46

APSB-22339(TX)-0615 MGM/FBS Beaumont ISD

The policy and any attached riders contain a waiting period during which no benefits will be paid. If any covered person has a specified disease diagnosed before the end of the waiting period immediately following the covered person’s effective date, coverage for that person will apply only to loss that is incurred after one year from the covered person’s effective date. If any covered person is diagnosed as having a specified disease during the waiting period immediately following the covered person’s effective date, you may elect to void the certificate from the beginning and receive a full refund of premium. If the policy replaced group specified disease cancer coverage from any company that terminated within 30 days of the certificate effective date, the waiting period will be waived for those covered persons that were covered under the prior coverage. However, the pre-existing condition exclusion provision will still apply.

GC14 Limited Benefit Group Cancer Indemnity Insurance Termination of Certificate

Insurance coverage under the certificate and any attached riders will end on the earliest of these dates: the date the policy terminates; the end of the grace period if the premium remains unpaid; the date insurance has ceased on all persons covered under this certificate; the end of the certificate month in which the policyholder requests to terminate this coverage; the date you no longer qualify as an insured; or the date of your death.

Termination of Coverage

Insurance coverage for a covered person under the certificate and any attached riders for a covered person will end as follows: the date the policy terminates; the date the certificate terminates; the end of the grace period if the premium remains unpaid; the end of the certificate month in which the policyholder requests to terminate the coverage for an eligible dependent; the date a covered person no longer qualifies as an insured or eligible dependent; or the date of the covered person’s death. We may end the coverage of any Covered Person who submits a fraudulent claim.

Cancer Screening Benefits Limitations and Exclusions

No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; losses or medical expenses incurred prior to the covered person’s effective date of this rider; or loss incurred during the pre-existing condition exclusion period following the covered person’s effective date of this rider as a result of a pre-existing condition. For the purpose of benefits under this rider, the waiting period will begin on the covered person’s effective date of this rider.

Surgical Benefits Limitations and Exclusions

No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; losses or medical expenses incurred prior to the covered person’s effective date of this rider regardless of when a specified disease was diagnosed; or loss incurred during the pre-existing condition exclusion period following the covered person’s effective date of this rider as a result of a pre-existing condition. For the purpose of benefits under this rider, the waiting period will begin on the covered person’s effective date of this rider.

Patient Care Benefits A hospital is not an institution, or part thereof, used as: a hospice unit, including any bed designated as a hospice or a swing bed; a convalescent home; a rest or nursing facility; a rehabilitative facility; an extended-care facility; or a facility primarily affording custodial, educational care, or care of treatment for persons suffering from mental diseases or disorders, or care for the aged, or drug or alcohol addiction.

Limitations and Exclusions

No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; losses or medical expenses incurred prior to the covered person’s effective date of this rider regardless of when a specified disease was diagnosed; or loss incurred during the pre-existing condition exclusion period following the covered person’s effective date of this rider as a result of a pre-existing condition. For the purpose of benefits under this rider, the waiting period will begin on the covered person’s effective date of this rider.

Only Loss for Cancer or Dread Disease

Pays only for loss resulting from definitive cancer treatment including direct extension, metastatic spread or recurrence. Proof must be submitted to support each claim. This rider also covers other conditions or diseases directly caused by cancer or the treatment of cancer. This rider does not cover any other disease, sickness or incapacity which existed prior to the diagnosis of cancer, even though after contracting cancer it may have been complicated, aggravated or affected by cancer or the treatment of cancer except for conditions specifically provided in the dread disease benefit.

You must remain disabled for 60 continuous days before this benefit will begin. The waiver of premium will begin on the next premium due date following the 60 consecutive days of disability. This benefit will continue for as long as you remain disabled until the earliest of either of the following: the date you are no longer disabled; the date coverage ends according to the termination provisions in the certificate; or the date coverage ends according to the termination provisions in this rider. Proof of disability must be provided for each new period of disability before a new waiver of premium benefit is payable.

Limitations and Exclusions

No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; losses or medical expenses incurred prior to the covered person’s effective date of this rider regardless of when a specified disease was diagnosed; or loss incurred during the pre-existing condition exclusion period following the covered person’s effective date of this rider as a result of a pre-existing condition. For the purpose of benefits under this rider, the waiting period will begin on the covered person’s effective date of this rider.

Termination of Cancer Screening, Surgical, Patient Care & Miscellaneous Benefit Rider(s) The above listed rider(s) will terminate and coverage will end for all covered persons on the earliest of: the end of the grace period if the premium for the rider remains unpaid; the date the policy or certificate to which the rider is attached terminates; the end of the certificate month in which APL receives a request from the policyholder to terminate the rider; or the date of your death. Coverage on an eligible dependent terminates under the rider when such person ceases to meet the definition of eligible dependent.]

Internal Cancer First Occurrence Benefits Pays a lump sum benefit amount when a covered person receives a first diagnosis of internal cancer and the date of diagnosis occurs after the waiting period. Only one benefit per covered person, per lifetime is payable under this benefit and the lump sum benefit amount will reduce by 50% at age 70.

Limitations and Exclusions

We will not pay benefits for a diagnosis of internal cancer received outside the territorial limits of the United States or a metastasis to a new site of any cancer diagnosed prior to the covered person’s effective date, as this is not considered a first diagnosis of an internal cancer.

Pre-Existing Condition Exclusion

No benefits are payable for any loss incurred during the pre-existing condition exclusion period following the covered person’s effective date of this rider as the result of a pre-existing condition.

Waiting Period

This rider contains a 30-day waiting period during which no benefits will be paid. If any internal cancer is diagnosed before the end of the waiting period immediately following the covered person’s effective date of this rider, coverage will apply only to loss that is incurred after one year from the covered person’s effective date of this rider.

Termination

This rider will terminate and coverage will end for all covered persons on the earliest of any of the following: the end of the grace period if the premium for this rider remains unpaid; the date the policy or certificate to which this rider is attached terminates; the end of the certificate month in which we receive a request from the policyholder to terminate this rider; the date of covered person’s death or the date the lump sum benefit amount for internal cancer has been paid for all covered persons under this rider. Coverage on an eligible dependent terminates under this rider when such person ceases to meet the definition of eligible dependent.

Miscellaneous Benefits Waiver of Premium

When the certificate is in force and you become disabled, we will waive all premiums due including premiums for any riders attached to the certificate. Disability must be due to cancer and occur while receiving treatment for such cancer.

APSB-22339(TX)-0615 MGM/FBS Beaumont ISD

GC14 Limited Benefit Group Cancer Indemnity Insurance Hospital Intensive Care Unit Benefits

Portability (Voluntary Plans Only)

Pays a daily benefit amount, up to the maximum number of days for any combination of confinement, for each day charges are incurred for room and board in an intensive care unit (ICU) or step-down unit due to an accident or sickness. Benefits will be paid beginning on the first day a covered person is confined in an ICU or step-down unit due to an accident or sickness that begins after the effective date of this rider. This benefit will reduce by 50% at age 70.

When you no longer meet the definition of Insured, you will have the option to continue this coverage, including any attached riders. No Evidence of Insurability will be required. Portability must meet all of the following conditions: the certificate has been continuously in force for the last 12 months; we receive a request and payment of the first premium for the portability coverage no later than 30 days after the date you no longer qualify as an eligible insured; and the policy, under which this certificate was issued, continues to be in force on the date you cease to qualify for coverage. All future premiums due will be billed directly to you. You are responsible for payment of all premiums for the portability coverage.

Limitations and Exclusions

For a newborn child born within the 10-month period following the effective date, no benefits under this rider will be provided for confinements that begin within the first 30 days following the birth of such child. No benefits under this rider will be provided during the first two years following the effective date for confinements caused by any heart condition when any heart condition was diagnosed or treated prior to the end of the 30-day period following the covered person’s effective date. The heart condition causing the confinement need not be the same condition diagnosed or treated prior to the effective date. We will not pay benefits for any loss caused by or resulting from any of the following: intentionally self-inflicted bodily injury, suicide or attempted suicide, whether sane or insane; alcoholism or drug addiction; any act of war, declared or undeclared, or any act related to war, or active service in the armed forces, or military service for any country at war; participation in any activity or event while intoxicated or under the influence of any narcotic unless administered by a physician or taken according to the physician’s instructions; participation in, or attempting to participate in, a felony, riot or insurrection (a felony is defined by the law of the jurisdiction in which the activity takes place).

The benefits, terms and condition of the portability coverage will be the same as those elected under the certificate immediately prior to the date you exercised portability. Portability coverage may include any eligible dependents who were covered under the certificate at the time you ceased to qualify as an eligible insured. No new eligible dependents may be added to the portability coverage except as provided in the New Born and Adopted Children provision. No increases in coverage will be allowed while you are exercising your rights under this rider. The premium for the portability coverage will be based on the premium tables used for such coverage at the time of the portability request. Coverage under this rider will terminate in accordance with the provisions of the Termination of Coverage in the certificate. If the policy is no longer in force, then portability coverage is not available.

Termination

This rider will terminate and coverage will end for all covered persons on the earliest of any of the following: the end of the grace period if the premium for this rider remains unpaid; the date the policy or certificate to which this rider is attached terminates; the end of the certificate month in which we receive a request from the policyholder to terminate this rider or the date of the covered person’s death. Coverage on an eligible dependent terminates under this rider when such person ceases to meet the definition of eligible dependent.

Optionally Renewable This policy/riders are optionally renewable. The policyholder or we have the right to terminate the policy/riders on any premium due date after the first anniversary following the policy/riders effective date. We must give at least 60 days written notice to the policyholder prior to cancellation.

2305 Lakeland Drive | Flowood, MS 39232 ampublic.com | 800.256.8606 Underwritten by American Public Life Insurance Company. This is a brief description of the coverage. For detailed benefits, limitations, exclusions and other provisions, please refer to the policy/certificate/riders. This coverage does not replace Workers’ Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. | This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and enforced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines. | Policy Form GC14 Series | TX | Limited Benefit Group Cancer Indemnity Insurance | (10/14) | MGM/FBS | Beaumont ISD 48

APSB-22339(TX)-0615 MGM/FBS Beaumont ISD

THE HARTFORD YOUR BENEFITS PACKAGE

Accident

About this Benefit Accident insurance is designed to supplement your medical insurance coverage by covering indirect costs that can arise with a serious, or a not-soserious, injury. Accident coverage is low cost protection available to you and your family without evidence of insurability.

2/3 of disabling injuries suffered by American workers are not work related. American workers 36% ofreport they always or

usually live paycheck to paycheck.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 50 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Beaumont ISD Benefits Website: www.mybenefitshub.com/beaumontisd

Accident GROUP VOLUNTARY ACCIDENT INSURANCE BENEFIT HIGHLIGHTS Beaumont Independent School District With Accident insurance, you’ll receive payment(s) associated with a covered injury and related services. You can use the payment in any way you choose – from expenses not covered by your major medical plan to day -to-day costs of living such as the mortgage or your utility bills.

More than 3.5 million children ages 14 and younger get hurt annually playing sports or participating in recreational activities.1

To learn more about Accident insurance, visit thehartford.com/employeebenefits

COVERAGE INFORMATION You have a choice of two accident plans, which allows you the flexibility to enroll for the coverage that best meets your needs. This insurance provides benefits when injuries, medical treatment and/or services occur as the result of a covered accident. Unless otherwise noted, the benefit amounts payable under each plan are the same for you and your dependent(s). PLAN INFORMATION LOW PLAN HIGH PLAN On and off-job (24 hour)

On and off-job (24 hour)

BENEFITS EMERGENCY, HOSPITAL & TREATMENT CARE

LOW PLAN

HIGH PLAN

Accident Follow-Up Acupuncture/Chiropractic Care Ambulance – Air Ambulance – Ground Blood/Plasma/Platelets Child Care Daily Hospital Confinement Daily ICU Confinement Diagnostic Exam Emergency Dental Emergency Room Health Screening Benefit Hospital Admission Initial Physician Office Visit Lodging Medical Appliance Physical Therapy Rehabilitation Facility Transportation Urgent Care X-ray

$75 $25 $1,500 $500 $200 $25 $200 $400 $200 Up to $300 $150 $50 $1,000 $75 $125 $100 $50 $150 $400 $100 $100

$100 $50 $2,000 $750 $300 $35 $400 $600 $300 Up to $450 $200 $50 $1,500 $100 $150 $200 $75 $300 $600 $150 $150

LOW PLAN

HIGH PLAN

Coverage Type

Up to 3 visits per accident Up to 10 visits each per accident Once per accident Once per accident Once per accident Up to 30 days per accident while insured is confined Up to 365 days per lifetime Up to 30 days per accident Once per accident Once per accident Once per accident Once per year for each covered person Once per accident Once per accident Up to 30 nights per lifetime Once per accident Up to 10 visits each per accident Up to 15 days per lifetime Up to 3 trips per accident Once per accident Once per accident

SPECIFIED INJURY & SURGERY Abdominal/Thoracic Surgery Arthroscopic Surgery Burn Burn – Skin Graft Concussion Dislocation Eye Injury Fracture Hernia Repair Joint Replacement Knee Cartilage Laceration Ruptured Disc Tendon/Ligament/Rotator Cuff

Once per accident Once per accident Once per accident Once per accident for third degree burn(s) Up to 3 per year Once per joint per lifetime Once per accident Once per bone per accident Once per accident Once per accident Once per accident Once per accident Once per accident Once per accident

$2,000 $3,000 $250 $500 Up to $10,000 Up to $15,000 50% of burn benefit 50% of burn benefit $150 $200 Up to $4,000 Up to $8,000 Up to $500 Up to $750 Up to $8,000 Up to $10,000 $200 $400 $2,000 $4,000 Up to $1,000 Up to $2,000 Up to $500 Up to $1,000 $1,000 $2,000 Up to $1,500 Up to $2,000 51

Accident CATASTROPHIC Accidental Death

Within 90 days; Spouse @ 50% and child @ 25%

Common Carrier Death Coma Dismemberment Home Health Care Paralysis Prosthesis

Within 90 days Once per accident Once per accident Up to 30 days per accident Once per accident Once per accident

FEATURES Ability Assist® EAP2 – 24/7/365 access to help for financial, legal or emotional issues HealthChampionSM3 – Administrative & clinical support following serious illness or injury

PREMIUMS The amounts shown are MONTHLY amounts (12 payments/deductions per year): 4 COVERAGE TIER LOW PLAN

LOW PLAN

HIGH PLAN

$50,000 1.5 times death benefit $10,000 Up to $50,000 $50 Up to $50,000 Up to $2,000

$75,000 1.5 times death benefit $15,000 Up to $75,000 $75 Up to $75,000 Up to $3,000

LOW PLAN

HIGH PLAN

Included Included

HIGH PLAN

Employee Only

$5.28 ($0.17 per day)

$8.34 ($0.27 per day)

Employee & Spouse

$8.32 ($0.27 per day)

$13.12 ($0.43 per day)

Employee & Child(ren)

$8.76 ($0.29 per day)

$13.94 ($0.46 per day)

Employee & Family

$13.82 ($0.45 per day)

$21.92 ($0.72 per day)

ASKED & ANSWERED WHO IS ELIGIBLE? You are eligible for this insurance if you are an active full-time employee who works at least 20 hours per week on a regularly scheduled basis. Your spouse and child(ren) are also eligible for coverage. Any child(ren) must be under age 26. CAN I INSURE MY DOMESTIC OR CIVIL UNION PARTNER? Yes. Any reference to “spouse” in this document includes your domestic partner, civil union partner or equivalent, as recognized and allowed by applicable law. AM I GUARANTEED COVERAGE? This insurance is guaranteed issue coverage – it is available without having to provide information about your or your family’s health. All you have to do is elect the coverage to become insured.

HOW MUCH DOES IT COST AND HOW DO I PAY FOR THIS INSURANCE? Premiums are provided above. You may elect insurance for you only, or for you and your dependent(s), by choosing the applicable coverage tier. Premiums will be automatically paid through payroll deduction, as authorized by you during the enrollment process. This ensures you don’t have to worry about writing a check or missing a payment. WHEN CAN I ENROLL? You may enroll during any scheduled enrollment period, or within 31 days of the date you have a change in family status. 52

WHEN DOES THIS INSURANCE BEGIN? Insurance will become effective in accordance with the terms of the certificate (usually the first day of the month following the date you elect coverage). You must be actively at work with your employer on the day your coverage takes effect. Your spouse and child(ren) must be performing normal activities and not be confined (at home or in a hospital/care facility), unless already insured with the prior carrier. WHEN DOES THIS INSURANCE END? This insurance will end when you or your dependents no longer satisfy the applicable eligibility conditions, premium is unpaid, you are no longer actively working, you leave your employer, or the coverage is no longer offered. CAN I KEEP THIS INSURANCE IF I LEAVE MY EMPLOYER OR AM NO LONGER A MEMBER OF THIS GROUP? Yes, you can take this coverage with you. Coverage may be continued for you and your dependent(s) under a group portability policy. Your spouse may also continue insurance in certain circumstances. The specific terms and qualifying events for portability are described in the certificate. 1“Sports Injury Statistics.” Stanford Children’s Health, n.d. Web. 30 June 2017. http://www.stanfordchildrens.org/en/topic/default?id=sports-injury-statistics-90 -P02787 2AbilityAssist® services are offered through The Hartford by ComPsych®. ComPsych is not affiliated with The Hartford and is not a provider of insurance services. The Hartford is not responsible and assumes no liability for the goods and services provided by ComPsych and reserves the right to discontinue any of these services at any time. Ability Assist is a registered trademark of The Hartford. Services may not be available in all states. Visit https://

Accident www.thehartford.com/employee-benefits/value-added-services for more information. 3HealthChampion services are provided through The Hartford by ComPsych®. ComPsych is not affiliated with The Hartford and is not a provider of insurance services. The Hartford doesn’t provide basic hospital, basic medical, or major medical insurance. HealthChampion specialists are only available during business hours. Inquiries outside of this timeframe can either request a call-back the next day or schedule an appointment. The Hartford is not responsible and assumes no liability for the goods and services provided by ComPsych and reserves the right to discontinue any of these services at any time. Health Champion is a service mark of ComPsych. Services may not be available in all states. Visit https://www.thehartford.com/employee-benefits/value-added-services for more information. 4Rates and/or benefits may be changed. Prepare. Protect. Prevail. With The Hartford. ® The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including issuing companies Hartford Life Insurance Company and Hartford Life and Accident Insurance Company. Home Office is Hartford, CT. 5962g NS 08/16 © 2016 The Hartford Financial Services Group, Inc. All rights reserved. This Benefit Highlights document explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this document and the policy, the terms of the policy apply. Benefits are subject to state availability. Policy terms and conditions vary by state. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy as issued to the policyholder. Accident Form Series includes GBD-2000, GBD-2300, or state equivalent.

LIMITATIONS & EXCLUSIONS This insurance coverage includes certain limitations and exclusions. The certificate details all provisions, limitations, and exclusions for this insurance coverage. A copy of the certificate can be obtained from your employer.

•

• •

medically necessary While a covered person is on any aircraft: as a pilot, crewmember or student pilot; as a flight instructor or examiner; if it is owned, operated or leased by or on behalf of the policyholder, or any employer or organization whose eligible persons are covered under the policy; or being used for tests, experimental purposes, stunt flying,racing or endurance tests Operating, learning to operate, serving as a crew member of or jumping or falling from any aircraft Riding in or driving any motor-driven vehicle in a race, stunt show or speed test

All exclusions may not be applicable, or may be adjusted, as required by state regulations in the situs state of a group. NOTICES THIS IS A LIMITED ACCIDENT ONLY BENEFIT POLICY IMPORTANT NOTICE – THIS POLICY DOES NOT PROVIDE COVERAGE FOR SICKNESS. This limited benefit plan (1) does not constitute major medical coverage, and (2) does not satisfy the individual mandate of the Affordable Care Act (ACA) because the coverage does not meet the requirements of minimum essential coverage. For New York Residents: This policy provides ACCIDENT insurance only. It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York State Department of Financial Services. IMPORTANT NOTICE — THIS POLICY DOES NOT PROVIDE COVERAGE FOR SICKNESS

GROUP ACCIDENT INSURANCE LIMITATIONS AND EXCLUSIONS The benefits payable are based on the insurance in effect on the date of the covered accident, subject to the definitions, 5962g NS 08/16 © 2016.The Hartford Financial Services Group, Inc. All rights reserved. Accident Form Series includes GBD-2000, GBD-2300, or state limitations, exclusions and other provisions of the policy. equivalent.

You and your dependent(s) must be citizens or legal residents of the United States, its territories and protectorates. This insurance does not provide benefits for any loss that results from or is caused by: • Suicide or attempted suicide, whether sane or insane, or intentionally self-inflicted injury • War or act of war, whether declared or undeclared, or a nuclear, chemical, biological, or radiological event • A covered person's participation in a felony, riot or insurrection • A covered person's service in the armed forces or units auxiliary to it • A covered person's taking drugs, unless as prescribed by or administered by a physician, or being intoxicated as defined by the jurisdiction in which the cause of loss was incurred • A covered person’s sickness or bacterial infection • A covered person’s participation in bungee jumping or hang gliding • A covered person’s participation or competition in semiprofessional or professional sports • Cosmetic surgery or any other elective procedure that is not

Prepare. Protect. Prevail. With The Hartford. ® The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including issuing companies Hartford Life Insurance Company and Hartford Life and Accident Insurance Company. Home Office is Hartford, CT. This Benefit Highlights document explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this document and the policy, the terms of the policy apply. Benefits are subject to state availability. Policy terms and conditions vary by state. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy as issued to the policyholder.

AUL A ONE AMERICA COMPANY

Life and AD&D

YOUR BENEFITS PACKAGE

About this Benefit Group term life is the most inexpensive way to purchase life insurance. You have the freedom to select an amount of life insurance coverage you need to help protect the well-being of your family. Accidental Death & Dismemberment is life insurance coverage that pays a death benefit to the beneficiary, should death occur due to a covered accident. Dismemberment benefits are paid to you, according to the benefit level you select, if accidentally dismembered.

Motor vehicle crashes are the

cause of accidental deaths in the US, followed by poisoning, falls, drowning, and choking.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 54 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Beaumont ISD Benefits Website: www.mybenefitshub.com/beaumontisd

Basic Life and AD&D Group Term Life including matching AD&D Coverage •

Life and AD&D insurance coverage amount of $10,000 at no cost to you

•

Waiver of premium benefit

•

Accelerated life benefit

•

Additional AD&D Benefits: Seat Belt, Air Bag, Repatriation, Child Higher Education, Child Care, Paralysis/Loss of Use, Severe Burns

Coverage options are available to eligible employees This invitation to inquire allows eligible employees an opportunity to inquire further about AUL's group insurance and is limited to a brief description of any losses for which benefits are payable. The contract has exclusions, limitations reduction of benefits, and terms under which the contract may be continued in force or discontinued. Products and financial services provided by American United Life Insurance Company® a ONEAMERICA® company. Visit us at www.oneamerica.com for more information.

What you need to know: Are you eligible? Benefits are available to employees who are actively at work on the effective date of coverage and working the minimum number of hours per week stated in the contract. Your premiums and benefits may vary. Actual premiums and benefit amounts will be calculated by OneAmerica and may change upon reaching certain ages, according to contract terms, and are subject to change. Volumes and benefit amounts shown may be subject to reductions due to age.

Enroll timely for guaranteed issue coverage. You may be eligible for coverage without having to answer any health questions if you enroll during the initial enrollment period when benefits are first offered by OneAmerica®, or if you enroll as a newly hired employee within 31 days after any applicable waiting period. Enrolling later requires approval. If you decline coverage now, you will lose your only chance to apply for group insurance coverage without having to first undergo medical underwriting. If you decide to enroll later, you will need to submit a Statement of Insurability form for review. OneAmerica will then decide to approve or deny your coverage based on your health history. You may not be approved for any type of coverage at a later date if you have any current or future medical conditions.

What you need to do: Carefully review the contents of this packet. Enclosed is personal information about the benefits offered to you by OneAmerica on behalf of your employer. This is your opportunity to learn more about group insurance from OneAmerica, but it is not a complete explanation of benefits. For more information, consult the contract about exclusions, limitations, reduction of benefits, and terms under which the contract may be continued in force or discontinued. Review the Notices and Limitations. Visit www.employeebenefits.aul.com to find the Notices and Limitations

Voluntary Life What you need to know about your Voluntary Term Life Benefits Flexible Life Options: • Employee: $20,000 to $500,000, in $10,000 increments, not to exceed 7 times your annual salary • Spouse under age 99: $10,000 to $500,000, in $5,000 increments, not to exceed 100% of the employee’s amount Life Guaranteed Issue: • Employee: $200,000 • Spouse: $50,000 • Child: $10,000 Dependent Life Coverage: Optional dependent life coverage is available to eligible employees. You must select employee coverage in order to cover your spouse and/or child(ren).

Accelerated Life Benefit: If diagnosed with a terminal illness and have less than 12 months to live, you may apply to receive 25%, 50% or 75% of your life insurance benefit to use for whatever you choose. Guaranteed Increase In Benefit: You may be eligible to increase your coverage annually until you reach your maximum amount without providing evidence of insurability. Reductions: Upon reaching certain ages, your original benefit amount will reduce to the percentage shown in the following schedule. The amounts of dependent life insurance and dependent AD&D principal sum will reduce according to the employee's reduction schedule. Age:

Reduces To:

67%

45% Payroll Deduction Illustration: Monthly Employee Options

Life 0-19 $20,000 $1.40 $40,000 $2.80 $60,000 $4.20 $80,000 $5.60 $100,000 $7.00 $120,000 $8.40 $140,000 $9.80 $160,000 $11.20 $180,000 $12.60 $200,000 $14.00

Life $10,000 $20,000 $30,000 $40,000 $50,000

0-19 $.70 $1.40 $2.10 $2.80 $3.50

Life Option 1:

20-24

25-29

30-34

35-39

40-44

45-49

50-54

$1.40 $2.80 $4.20 $5.60 $7.00 $8.40 $9.80 $11.20 $12.60 $14.00

$1.60 $3.20 $4.80 $6.40 $8.00 $9.60 $11.20 $12.80 $14.40 $16.00

$2.40 $4.80 $7.20 $9.60 $12.00 $14.40 $16.80 $19.20 $21.60 $24.00

$2.80 $5.60 $8.40 $11.20 $14.00 $16.80 $19.60 $22.40 $25.20 $28.00

$3.00 $6.00 $9.00 $12.00 $15.00 $18.00 $21.00 $24.00 $27.00 $30.00

$4.40 $8.80 $13.20 $17.60 $22.00 $26.40 $30.80 $35.20 $39.60 $44.00

$6.80 $12.40 $19.00 $13.60 $24.80 $38.00 $20.40 $37.20 $57.00 $27.20 $49.60 $76.00 $34.00 $62.00 $95.00 $40.80 $74.40 $114.00 $47.60 $86.80 $133.00 $54.40 $99.20 $152.00 $61.20 $111.60 $171.00 $68.00 $124.00 $190.00

20-24 $.70 $1.40 $2.10 $2.80 $3.50

25-29 $.70 $1.40 $2.10 $2.80 $3.50

30-34 $.80 $1.60 $2.40 $3.20 $4.00

35-39 $1.20 $2.40 $3.60 $4.80 $6.00

50-54 $2.20 $4.40 $6.60 $8.80 $11.00

55-59 $3.40 $6.80 $10.20 $13.60 $17.00

Child(ren) 6 months to age 26 $10,000

Spouse Options 40-44 45-49 $1.40 $1.50 $2.80 $3.00 $4.20 $4.50 $5.60 $6.00 $7.00 $7.50

Child Options Child(ren) live birth to 6 months $10,000

55-59

60-64

60-64 $6.20 $12.40 $18.60 $24.80 $31.00

65-69

65-69 $9.50 $19.00 $28.50 $38.00 $47.50

70-74

75+

$37.00 $74.00 $111.00 $148.00 $185.00 $222.00 $259.00 $296.00 $333.00 $370.00

70-74 $18.50 $37.00 $55.50 $74.00 $92.50

75+ $18.50 $37.00 $55.50 $74.00 $92.50

Deduction Amount Child(ren) $1.51

Note: Employee and Spouse premiums are based on your age as of 09/01 and amount of coverage chosen. Child premiums are for all eligible children combined.

OneAmerica® is the marketing name for the companies of OneAmerica. G 00614201-0000-000 Beaumont Independent School District Class: 1 Rate Effective Date:10/1/2015

Voluntary Life What you need to know about your Voluntary AD&D Benefits Accidental Death and Dismemberment (AD&D): You must select Life coverage in order to select any AD&D coverage. If AD&D is selected, additional life insurance benefits may be payable in the event of an accident which results in death or dismemberment as defined in the contract. Additional AD&D benefits include seat belt, air bag, repatriation, child higher education, child care, paralysis/ loss of use, severe burns, disappearance, and exposure. Flexible AD&D Options: Employee: Up to $500,000, in $10,000 increments Dependent AD&D Coverage: If employee AD&D coverage and dependent Life coverage are selected, matching AD&D will be included in any selected spouse and child(ren) coverage. If employee AD&D is declined, no dependent AD&D will be included. Guaranteed Increase In Benefit: You may be eligible to increase your coverage annually until you reach your maximum amount without providing evidence of insurability. Reductions: Upon reaching certain ages, your original benefit amount will reduce to the percentage shown in the following schedule. The amounts of dependent life insurance and dependent AD&D principal sum will reduce according to the employee's reduction schedule. Age: 70 75 Reduces To:

67%

45%

Payroll Deduction Illustration: Monthly Employee Options AD&D $20,000 $40,000 $60,000 $80,000 $100,000 $120,000 $140,000 $160,000 $180,000 $200,000

0-19 $.52 $1.04 $1.56 $2.08 $2.60 $3.12 $3.64 $4.16 $4.68 $5.20

20-24 $.52 $1.04 $1.56 $2.08 $2.60 $3.12 $3.64 $4.16 $4.68 $5.20

25-29 $.52 $1.04 $1.56 $2.08 $2.60 $3.12 $3.64 $4.16 $4.68 $5.20

30-34 $.52 $1.04 $1.56 $2.08 $2.60 $3.12 $3.64 $4.16 $4.68 $5.20

35-39 $.52 $1.04 $1.56 $2.08 $2.60 $3.12 $3.64 $4.16 $4.68 $5.20

40-44 $.52 $1.04 $1.56 $2.08 $2.60 $3.12 $3.64 $4.16 $4.68 $5.20

45-49 $.52 $1.04 $1.56 $2.08 $2.60 $3.12 $3.64 $4.16 $4.68 $5.20

50-54 $.52 $1.04 $1.56 $2.08 $2.60 $3.12 $3.64 $4.16 $4.68 $5.20

55-59 $.52 $1.04 $1.56 $2.08 $2.60 $3.12 $3.64 $4.16 $4.68 $5.20

60-64 $.52 $1.04 $1.56 $2.08 $2.60 $3.12 $3.64 $4.16 $4.68 $5.20

65-69 $.52 $1.04 $1.56 $2.08 $2.60 $3.12 $3.64 $4.16 $4.68 $5.20

70-74 $.52 $1.04 $1.56 $2.08 $2.60 $3.12 $3.64 $4.16 $4.68 $5.20

75+ $.52 $1.04 $1.56 $2.08 $2.60 $3.12 $3.64 $4.16 $4.68 $5.20

AD&D $10,000 $20,000 $30,000 $40,000 $50,000

0-19 $.52 $.78 $1.04 $1.30

20-24 $.52 $.78 $1.04 $1.30

25-29 $.52 $.78 $1.04 $1.30

30-34 $.52 $.78 $1.04 $1.30

35-39 $.52 $.78 $1.04 $1.30

Spouse Options 40-44 45-49 $.52 $.52 $.78 $.78 $1.04 $1.04 $1.30 $1.30

50-54 $.52 $.78 $1.04 $1.30

55-59 $.52 $.78 $1.04 $1.30

60-64 $.52 $.78 $1.04 $1.30

65-69 $.52 $.78 $1.04 $1.30

70-74 $.52 $.78 $1.04 $1.30

75+ $.52 $.78 $1.04 $1.30

AD&D Option 1:

Child(ren) 6 months to age 26 $10,000

Child Options Child(ren) live birth to 6 months $10,000

Deduction Amount Child(ren) $0.26

Note: Employee and Spouse premiums are based on your age as of 09/01 and amount of coverage chosen. Child premiums are for all eligible children combined.

OneAmerica® is the marketing name for the companies of OneAmerica. G 00614201-0000-000 Beaumont Independent School District Class: 1 Rate Effective Date:10/1/2015

ComPsych GuidanceResources® Program “Employee Assistance Program" this benefit is provided by BISD and no additional charge to the employee.

Call Your ComPsych® GuidanceResources® program anytime for confidential assistance. Call: 855.387.9727 TDD: 800.697.0353 Go online: guidanceresources.com Your company Web ID: ONEAMERICA3 Personal issues, planning for life events or simply managing daily life can affect your work, health and family. Your GuidanceResources program provides support, resources and information for personal and work-life issues. The program is companysponsored, confidential and provided at no charge to you and your dependents. This flyer explains how GuidanceResources can help you and your family deal with everyday challenges.

Confidential Counseling

Work-Life Solutions

3 Session Plan This no-cost counseling service helps you address stress, relationship and other personal issues you and your family may face. It is staffed by GuidanceConsultantsSM—highly trained master’s and doctoral level clinicians who will listen to your concerns and quickly refer you to in-person counseling (up to 3 sessions per year) and other resources for: › Stress, anxiety and depression › Job pressures › Relationship/marital conflicts › Grief and loss › Problems with children › Substance abuse

Delegate your “to-do” list. Our Work-Life specialists will do the research for you, providing qualified referrals and customized resources for: › Child and elder care › College planning › Moving and relocation › Pet care › Making major purchases › Home repair

Financial Information and Resources Discover your best options. Speak by phone with our Certified Public Accountants and Certified Financial Planners on a wide range of financial issues including: › Getting out of debt › Retirement planning › Credit card or loan problems › Estate planning › Tax questions › Saving for college

Legal Support and Resources Expert info when you need it. Talk to our attorneys by phone. If you require representation, we’ll refer you to a qualified attorney in your area for a free 30minute consultation with a 25% reduction in customary legal fees thereafter. Call about: › Divorce and family law › Real estate transactions › Debt and bankruptcy › Civil and criminal actions › Landlord/tenant issues › Contracts

GuidanceResources® Online Knowledge at your fingertips. GuidanceResources Online is your one stop for expert information on the issues that matter most to you… relationships, work, school, children, wellness, legal, financial, free time and more. › Timely articles, HelpSheetsSM, tutorials, streaming videos and self-assessments › “Ask the Expert” personal responses to your questions › Child care, elder care, attorney and financial planner searches

Free Online Will Preparation Get peace of mind. EstateGuidance® lets you quickly and easily write a will on your computer. Just go to www.guidanceresources.com and click on the EstateGuidance link. Follow the prompts to create and download your will at no cost. Online support and instructions for executing and filing your will are included. You can: › Name an executor to manage your estate › Choose a guardian for your children › Specify your wishes for your property › Provide funeral and burial instructions

Your ComPsych® GuidanceResources® Program CALL ANYTIME Call: 855.387.9727 TDD: 800.697.0353 Online: guidanceresources.com Your company Web ID: ONEAMERICA3 OneAmerica is the marketing name for American United Life Insurance Company® (AUL). AUL markets ComPsych services. ComPsych Corporation is not an affiliate of AUL and is not a OneAmerica company. Copyright © 2016 ComPsych Corporation. All rights reserved. To view the ComPsych HIPAA privacy notice, please go to www.guidanceresources.com/privacy.

Life and AD&D Upon verification of coverage, Generali Global Assistance will arrange and cover the cost of the following services, subject to policy limits and Providing you peace of mind when traveling eligibility: Emergencies happen, but help is now only a phone call or email away. • Emergency evacuation: $1,000,000 Combined Single Limit (CSL) Generali Global Assistance® offers a suite of services to help you in your • Medically necessary repatriation: Included in CSL time of need — from small inconveniences like losing your medication to • Repatriation or cremation of remains: Up to $25,000 life-threatening situations — all delivered with a caring, human touch. If traveling alone: Find comfort in knowing you and your loved ones are protected by the • Visit of family member or friend: Up to $5,000 Travel Assistance benefit when traveling more than 100 miles from • Return of minor children: Up to $5,000 home on a trip that lasts 90 days or less for business or pleasure. The • Traveling companion transportation: Up to $5,000 Travel Assistance benefit protects you when covered under a OneAmeri• Vehicle return: Up to $2,500 ca® group life insurance contract. It also extends coverage to your • Bereavement transportation: Up to $2,500 spouse, domestic partner and children, even when they are traveling • Pet return: Up to $1,000 without you.

TRAVEL ASSISTANCE

Note: Group life products are issued and underwritten by American United Life Insurance Company® (AUL), Indianapolis, In., a OneAmerica company. Not available in all states or may vary by state. Travel assisMedical assistance services tance provided by Generali Global Assistance. Generali Global Assistance • Medical and dental referral to assist in finding physicians, dentists is not an affiliate of AUL, and is not a OneAmerica Company. Generali and medical facilities. Global Assistance provides noted services worldwide for covered individ• Replacement of medication or eyeglasses that have been lost or uals. Services may be unavailable in countries currently under U.S. ecostolen, with guarantee of reimbursement by you. nomic or trade sanctions. A list of affected counties is available at treas• Medical monitoring and review of documentation utilizing profesury.gov/resource-center/ sanctions/Programs/Pages/Programs.aspx. sional case managers and medical professionals to ensure appropri- Please refer to your policy for covered limits and eligibility details. ate care is received. • Visitation with a family member or a friend if you are traveling When contacting Generali Global Assistance, be prepared to provide: alone and must be hospitalized for at least seven days or are listed • The name of your employer as in critical condition. • A phone number where you can be reached • Dependent children assistance in the event you are hospitalized, including payment for their trip home and a qualified escort to accompany them. For assistance call: • Traveling companion assistance in the event they must cancel their 1-866-294-2469 (US/Canada) travel arrangements due to medical emergencies. +1-240-330-1509 (call collect from other locations) • Emergency evacuation in the event you must be transported to a medical facility or home under medical supervision. or email ops@europassistance-usa.com • Repatriation or cremation of remains in the event of death while traveling. • Trip interruption to arrange alternate transportation and accommodations necessary due to a medical emergency. • Emergency medical payment to cover medical and dental care expenses in the case of sudden, unexpected illness or injury during your trip, with guarantee of reimbursement by you. The Travel Assistance benefit requires no additional premium; however, exclusions do apply.

Personal assistance services • Pre-trip informational services including: visa, passport, immunization requirements, weather conditions, travel advisories and more. • Language interpretation for all major languages. • Location or replacement of lost or stolen items such as luggage, documents and personal possessions. • Emergency cash advance subject to guarantee of reimbursement by you. • Emergency travel arrangements when appropriate, such as airline changes or hotel and car rental reservations. • Legal assistance and advanced bail bond will be arranged, where permitted by law, with guarantee of reimbursement by you. • Emergency message relay via toll- free, direct or collect access. • Vehicle return arranged and paid for if you become physically unable to operate a non-commercial vehicle due to a medical emergency. • Pet return home coordinated if covered traveler is hospitalized.

ONEAMERICA® IS THE MARKETING NAME FOR THE COMPANIES OF ONEAMERICA | ONEAMERICA.COM G-29706 05/09/17

TEXAS LIFE

Individual Life

About this Benefit Individual life is a policy that provides a specified death benefit to your beneficiary at the time of death. The advantage of having an individual life insurance plan as opposed to a group supplemental term life plan is that this plan is guaranteed renewable, portable and typically premiums remain the same over the life of the policy.

YOUR BENEFITS PACKAGE

Experts recommend at least

x 10 your gross annual income in coverage when purchasing life insurance.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 60 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Beaumont ISD Benefits Website: www.mybenefitshub.com/beaumontisd

Individual Life Life Insurance Highlights For the Employee Voluntary permanent life insurance can be an ideal complement to the group term and optional term your employer might provide. Designed to be in force when you die, this voluntary universal life product is yours to keep, even when you change jobs or retire, as long as you pay the necessary premium. Group and voluntary term, on the other hand, typically are not portable if you change jobs and, even if you can keep them after you retire, usually cost more and decline in death benefit. The policy, purelife-plus, is underwritten by Texas Life Insurance Company, and it has the following features: • •

• •

•

High Death Benefit. With one of the highest death benefits available at the worksite,1 purelife-plus gives your loved ones peace of mind. Minimal Cash Value. Designed to provide a high death benefit at a reasonable premium, purelife-plus provides peace of mind for you and your beneficiaries while freeing investment dollars to be directed toward such tax-favored retirement plans as 403(b), 457 and 401(k). Long Guarantees.2 Enjoy the assurance of a policy that has a guaranteed death benefit to age 121 and level premium that guarantees coverage for a significant period of time.3 Refund of Premium. Unique in the marketplace, purelife-plus offers you a refund of 10 years’ premium, should you surrender the policy if the premium you pay when you buy the policy ever increases. (Conditions apply.) Accelerated Death Benefit Rider. Should you be diagnosed as terminally ill with the expectation of death within 12 months (24 months in Illinois), you will have the option to receive 92% (84% in Illinois) of the death benefit, minus a $150 ($100 in Florida) administrative fee. This valuable living benefit gives you peace of mind knowing that, should you need it, you can take the large majority of your death benefit while still alive. (Conditions apply.)

You may apply for this permanent, portable coverage, not only for yourself, but also for your spouse, children and grandchildren by answering just 3 questions:4

During the last six months, has the proposed insured: a. b. c.

Been actively at work on a full time basis, performing usual duties? Been absent from work due to illness or medical treatment for a period of more than five consecutive working days Been disabled or received tests, treatment or care of any kind in a hospital or nursing home or received chemotherapy, hormonal therapy for cancer, radiation therapy, dialysis treatment, or treatment for alcohol or drug abuse?

Like most life insurance policies, Texas Life policies contain certain exclusions, limitations, exceptions, reductions of benefits, waiting periods and terms for keeping them in force. Please contact a Texas Life representative for costs and complete details.

Voluntary and Universal Whole Life Products, Eastbridge Consulting Group, October 2012 2 Guarantees are subject to product terms, exclusions and limitations and the insurer’s claims-paying ability and financial strength. 3 After the guaranteed period, premiums may go down, stay the same, or go up. 4 Coverage and spouse/domestic partner eligibility may vary by state. Texas Life complies with all state laws regarding marriages, domestic and civil union partnerships, and legally recognized familial relationships. Coverage not available on children and grandchildren in Washington. 61

UNUM

Critical Illness

Critical illness insurance is designed to supplement your medical and disability coverage easing the financial impacts by covering some of your additional expenses. It providesisadesigned benefit payable directly to the Critical illness insurance to supplement of a covered condition yourinsured medicalupon and diagnosis disability coverage easing the or event,impacts like a heart attack or stroke. financial by covering some of your additional

YOUR BENEFITS PACKAGE

About this Benefit

expenses. It provides a benefit payable directly to the insured upon diagnosis of a covered condition or event, like a heart attack or stroke.

$16,500 Is the aggregate cost of a hospital stay for a heart attack.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 62 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Beaumont ISD Benefits Website: www.mybenefitshub.com/beaumontisd

Critical Illness Critical Illness insurance provides financial protection by paying a lump sum benefit if you are diagnosed with a covered critical illness. Who is eligible for this coverage? What are the Critical Illness coverage amounts?

Can I be denied coverage? When is coverage effective?

All employees in active employment in the United States working at least 20 hours per week and their eligible spouses and children (up to age 26 regardless of student or marital status). The following coverage amounts are available. For you: Select one of the following choice Employee - $10,000, $20,000 or $30,000 For your Spouse and Children: 100% of employee coverage amount Coverage is guarantee issue. Please see your Plan Administrator for your effective date of coverage. Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.

What critical illness conditions are covered? Covered Conditions* Critical Illnesses: Coronary Artery Disease (major) Coronary Artery Disease (minor) End Stage Renal (Kidney) Failure Heart Attack (Myocardial Infarction) Major Organ Failure Requiring Transplant Stroke Supplemental Critical Illnesses: Benign Brain Tumor Coma Loss of Hearing Loss of Sight Loss of Speech Infectious Disease Occupational Human Immunodeficiency Virus (HIV) or Hepatitis Permanent Paralysis Progressive Diseases: Amyotrophic Lateral Sclerosis (ALS) Dementia (including Alzheimer's Disease) Functional Loss Multiple Sclerosis (MS) Parkinson's Disease Additional Critical Illnesses for your Children: Cerebral Palsy Cleft Lip or Palate Cystic Fibrosis Down Syndrome Spina Bifida *Please refer to the policy for complete definitions of covered conditions.

Percentage of Coverage Amount 50% 10% 100% 100% 100% 100% 100% 100% 100% 100% 100% 25% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Covered Condition Benefit The covered condition benefit is payable once per covered condition per insured. Unum will pay a covered condition benefit for a different covered condition if: • the new covered condition is medically unrelated to the first covered condition; or • the dates of diagnosis are separated by more than 180 days. Reoccurring Condition Benefit We will pay the reoccurring condition benefit for the diagnosis of the same covered condition if the covered condition benefit was previously paid and the new date of diagnosis is more than 180 days after the prior date of diagnosis. The benefit amount for any reoccurring condition benefit is 100% of the percentage of coverage amount for that condition. The following Covered Conditions are eligible for a reoccurring condition benefit: • Benign Brain Tumor • Major Organ Failure Requiring • End Stage Renal (Kidney) Failure • Heart Attack (Myocardial Infarction) Transplant • Coronary Artery Disease (Minor) • Coma • Coronary Artery Disease (Major) • Stroke 63

Critical Illness How much does the coverage cost? Option 1

Option 3

Monthly Critical Illness Cost - $10,000 EE, $10,000 SP

Monthly Critical Illness Cost - $30,000 EE, $30,000 SP

Age

Employee Cost

Spouse Cost

Age

Employee Cost

Spouse Cost

Less than age 25

$1.10

Less than age 25

$3.30

25 - 29

$1.40

25 - 29

$4.20

30 - 34

$1.80

30 - 34

$5.40

35 - 39

$2.50

35 - 39

$7.50

40 - 44

$3.40

40 - 44

$10.20

45 - 49

$4.80

45 - 49

$14.40

50 - 54

$6.60

50 - 54

$19.80

55 - 59

$8.60

55 - 59

$25.80

60 - 64

$12.60

60 - 64

$37.80

65 - 69

$20.00

65 - 69

$60.00

70 - 74

$37.30

70 - 74

$111.90

75 - 79

$64.20

75 - 79

$192.60

80 - 84

$110.80

80 - 84

$332.40

85 or over

$203.10

85 or over

$609.30

Option 2 Monthly Critical Illness Cost - $20,000 EE, $20,000 SP Age

Employee Cost

Spouse Cost

Less than age 25

$2.20

25 - 29

$2.80

30 - 34

$3.60

35 - 39

$5.00

40 - 44

$6.80

45 - 49

$9.60

50 - 54

$13.20

55 - 59

$17.20

60 - 64

$25.20

65 - 69

$40.00

70 - 74

$74.60

75 - 79

$128.40

80 - 84

$221.60

85 or over

$406.20

Your rate is based on your insurance age, which is your age immediately prior to and including the anniversary/effective date. Spouse rate is based on your Spouse’s insurance age, which is their age immediately prior to and including the anniversary/ effective date.

Critical Illness Do my critical illness insurance benefits decrease with age? Critical Illness benefits do not decrease due to age. Are there any exclusions or limitations? We will not pay benefits for a claim that is caused by, contributed to by, or occurs as a result of any of the following: • committing or attempting to commit a felony; • being engaged in an illegal occupation or activity; • injuring oneself intentionally or attempting or committing suicide, whether sane or not; • active participation in a riot, insurrection, or terrorist activity. This does not include civil commotion or disorder, injury as an innocent bystander, or Injury for self-defense; • participating in war or any act of war, whether declared or undeclared; • combat or training for combat while serving in the armed forces of any nation or authority, including the National Guard, or similar government organizations; • voluntary use of or treatment for voluntary use of any prescription or nonprescription drug, alcohol, poison, fume, or other chemical substance unless taken as prescribed or directed by the Insured’s Physician; • being intoxicated; and • a Date of Diagnosis that occurs while an Insured is legally incarcerated in a penal or correctional institution. Additionally, no benefits will be paid for a Date of Diagnosis that occurs prior to the coverage effective date. Pre-existing Conditions We will not pay benefits for a claim when the covered loss occurs in the first 12 months following an insured’s coverage effective date and the covered loss is caused by, contributed to by, or occurs as a result of any of the following: • a pre-existing condition; or • complications arising from treatment or surgery for, or medications taken for, a pre-existing condition. An insured has a pre-existing condition if, within the 3 months just prior to their coverage effective date, they have an injury or sickness, whether diagnosed or not, for which: • medical treatment, consultation, care or services, or diagnostic measures were received or recommended to be received during that period; • drugs or medications were taken, or prescribed to be taken during that period; or • symptoms existed. The pre-existing condition provision applies to any Insured’s initial coverage and any increases in coverage. Coverage effective date refers to the date any initial coverage or increases in coverage become effective.

Is the coverage portable (can I keep it if I leave my employer)? If you have been insured for at least 12 months and your employment with your employer ends or you are no longer in an eligible group you can apply for ported coverage and pay the first premium within 31 days to continue coverage for yourself, your spouse and your children. If your spouse’s coverage ends as a result of your death, divorce or annulment, your spouse may elect to continue spouse and children coverage, as long as premium is paid as required. When does my coverage end? If you choose to cancel coverage, it will end on the first of the month following the date you provide notification to your employer. Otherwise, coverage ends on the earliest of: • the date the policy is cancelled by your employer; • the date you no longer are in an eligible group; • the date your eligible group is no longer covered; • the date of your death • the last day of the period any required contributions are made; • the last day you are in active employment. If you choose to cancel your Spouse’s coverage, it will end on the first of the month following the date you provide notification to your employer. Otherwise, your spouse’s coverage will end on the earliest of: • the date your coverage ends; • the date your spouse is no longer eligible for coverage; • the date your spouse no longer meets the definition of a spouse; • the date of your spouse’s death; or • the date of divorce or annulment. Your children’s coverage will end on the earliest of: • the date your coverage ends; • the date your children are no longer eligible for coverage; or • the date your children no longer meet the definition of children. The limited benefits provided are a supplement to major medical coverage and are not a substitute for major medical coverage or other minimal essential coverage as required by federal law. Lack of minimal essential coverage may result in an additional tax payment being due. This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form GCIP16-1 et al or contact your Unum representative. © 2017 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. Underwritten by Unum Insurance Company, Portland, Maine 65

ID WATCHDOG

Identity Theft

YOUR BENEFITS PACKAGE

About this Benefit Identity theft protection monitors and alerts you to identity threats. Resolution services are included should your identity ever be compromised while you are covered.

An identity is stolen every 2 seconds, and takes over

300 hours

to resolve, causing an average loss of $9,650.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 66 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Beaumont ISD Benefits Website: www.mybenefitshub.com/beaumontisd

Identity Theft Because There’s Only One You. Your identity is important — it’s what makes you, you. You’ve spent a lifetime building your name and financial reputation. Let us help you better protect it. And, we’ll even go one step further and help you better protect the identities of your family.

1 in 18 consumers were victims of identity theft in 2018.1 Easy & Affordable Identity Protection With ID Watchdog®, you have an easy and affordable way to help better protect and monitor the identities of you and your family. You’ll be alerted to potentially suspicious activity and enjoy the peace of mind that comes with the support of dedicated resolution specialists. And, a customer care team that’s available any time, every day. WHY CHOOSE ID WATCHDOG Credit Lock With our online and in-app feature, lock your Equifax® credit report2 — and your child’s Equifax credit report — to help provide additional protection against unauthorized access to your credit.

More for Families Our family plan helps you better protect your loved ones, with each adult getting their own account with all plan features. And, we offer more features that help protect minors than any other provider.

ID Watchdog Monthly Rates 1B

Platinum

Individual Plan

$7.95

$11.95

Family Plan

$14.95

$22.95

Dedicated Resolution Specialists If you become a victim, you don’t have to face it alone. One of our certified resolution specialists will fully manage the case for you until your identity is restored.

ID Watchdog Is Here for You ID Watchdog is everywhere you can’t be — monitoring credit reports, social media, transaction records, public records and more — to help you better protect your identity. And don’t worry, we’re always here for you. In fact, our U.S.-based customer care team is available 24/7/365 at 866.513.1518. See our unique features and pricing and take a step to help better protect your identity today.

1 2019 Identity Fraud Study, Javelin Research, March 2019 2 Locking your Equifax credit report will prevent access to it by certain third parties. Locking your Equifax credit report will not prevent access to your credit report at any other credit reporting agency. Entities that may still have access to your Equifax credit report include: companies like ID Watchdog, which provide you with access to your credit report or credit score, or monitor your credit report as part of a subscription or similar service; companies that provide you with a copy of your credit report or credit score, upon your request; federal, state and local government agencies and courts in certain circumstances; companies using the information in connection with the underwriting of insurance, or for employment, tenant or background screening purposes; companies that have a current account or relationship with you, and collection agencies acting on behalf of those whom you owe; companies that authenticate a consumer’s identity for purposes other than granting credit, or for investigating or preventing actual or potential fraud; and companies that wish to make pre-approved offers of credit or insurance to you. To opt out of such pre-approved offers, visit www.optoutprescreen.com 67

Identity Theft Unique Features Included in All ID Watchdog Plans The Powerful Features You Want — All at an Affordable Price Monitor & Detect • Dark Web Monitoring1* •

Manage & Alert • Child Credit Lock3 | 1 Bureau* •

Financial Accounts Monitoring

•

Subprime Loan Monitoring *

•

Social Network Alerts*

•

Public Records Monitoring*

•

Registered Sex Offender Reporting*

•

USPS Change of Address Monitoring

•

Identity Profile Report

High-Risk Transactions Monitoring2*

Support & Restore • Identity Theft Resolution Specialists (Resolution for Pre-existing Conditions)* •

24/7/365 U.S.-based Customer Care Center

Customizable Alert Options

•

Lost Wallet Vault & Assistance

•

Breach Alert Emails

•

Mobile App

Deceased Family Member Fraud Remediation

•

Fraud Alert & Credit Freeze Assistance

*Helps better protect children | 1 Bureau = Equifax® | Multi-Bureau = Equifax, TransUnion® | 3 Bureau = Equifax, Experian®, TransUnion

What You Need to Know The credit scores provided are based on the VantageScore® 3.0 model. For three-bureau VantageScore credit scores, data from Equifax, Experian, and TransUnion are used respectively. Any one-bureau VantageScore uses Equifax data. Third parties use many different types of credit scores and are likely to use a different type of credit score to assess your creditworthiness. PLAN OPTIONS

ID WATCHDOG® 1B

ID WATCHDOG® PLATINUM

Credit Report(s)4 & VantageScore Credit Score(s)

1 Bureau Monthly

1 Bureau Daily & 3 Bureau Annually

Credit Score Tracker

1 Bureau Monthly

1 Bureau Daily

Credit Report Monitoring5

1 Bureau

3 Bureau

Credit Report Lock6

1 Bureau

Multi-Bureau

Identity Theft Insurance7

Up to $1M

401K/HSA Stolen Funds Reimbursement7

Up to $500k

SPECIAL EMPLOYEE PRICING PER MONTH

IDWATCHDOG® 1B

IDWATCHDOG® PLATINUM

Employee (Includes 1 child <18)

$7.95

$11.95

Employee + Family

$14.95

$22.95

Enroll in this valuable benefit today. Take steps to help better protect your identity.

Identity Theft 1 Dark Web Monitoring scans thousands of internet sites where consumers’ personal information is suspected of being bought and sold, and is constantly adding new sites to those it searches. However, the internet addresses of these suspected internet trading sites are not published and frequently change, so there is no guarantee that ID Watchdog is able to locate and search every possible internet site where consumers’ personal information is at risk of being traded. 2 The monitored network does not cover all businesses or transactions. 3 Locking your child’s Equifax credit report helps prevent access to it by lenders and creditors. It will not prevent access to your child’s credit report at any other credit reporting agency. 4 Under certain circumstances, access to your Equifax Credit Report may not be available as certain consumer credit files maintained by Equifax contain credit histories, multiple trade accounts, and/or an extraordinary number of inquiries of a nature that prevents or delays the delivery of your Equifax Credit Report. If a remedy for the failure is not available, the product subscription will be cancelled and a full refund will be made. 5 Monitoring from TransUnion® and Experian® will take several days to begin. 6 Locking your Equifax or TransUnion credit report will prevent access to it by certain third parties. Locking your Equifax or TransUnion credit report will not prevent access to your credit report at any other credit reporting agency. Entities that may still have access to your Equifax or TransUnion credit report include: companies like ID Watchdog and TransUnion Interactive, Inc. which provide you with access to your credit report or credit score, or monitor your credit report as part of a subscription or similar service; companies that provide you with a copy of your credit report or credit score, upon your request; federal, state, and local government agencies and courts in certain circumstances; companies using the information in connection with the underwriting of insurance, or for employment, tenant or background screening purposes; companies that have a current account or relationship with you, and collection agencies acting on behalf of those whom you owe; companies that authenticate a consumer’s identity for purposes other than granting credit, or for investigating or preventing actual or potential fraud; and companies that wish to make pre-approved offers of credit or insurance to you. To opt out of pre-approved offers, visit www.optoutprescreen.com. 7 The Identity Theft Insurance is underwritten and administered by American Bankers Insurance Company of Florida, an Assurant company. Please refer to the actual policies for terms, conditions, and exclusions of coverage. Coverage may not be available in all jurisdictions. Review the Summary of Benefits (www.idwatchdog.com/ terms/insurance). © 2019 ID Watchdog. Other product and company names are property of their respective owners. EE79376CG0819

DEER OAKS

EAP (Employee Assistance Program)

YOUR BENEFITS PACKAGE

About this Benefit An Employee Assistance Plan (EAP) is an employee benefit program offered to help employees manage personal and professional problems that might adversely impact their work performance, health, and well-being. Employee Assistance Plans generally include short-term counseling and referral services for employees and their household members. Your Employee Assistance Program benefit is provided to you by your employer.

38%

of employees have missed life events because of bad worklife balance.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 70 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Beaumont ISD Benefits Website: www.mybenefitshub.com/beaumontisd

Employee Assistance Program (EAP) The Deer Oaks Employee Assistance Program (EAP) is a free service provided for you and your dependents by your employer. This program offers a wide variety of counseling, referral, and consultation services, which are all designed to assist you and your family in resolving work/life issues in order to live happier, healthier, more balanced lives. These services are completely confidential and can be easily accessed by calling the toll-free Helpline. Below is an overview of the services available through your EAP:

Eligibility: All employees and their household members/ dependents are eligible to access the EAP. This includes retirees and employees who have recently separated from their employer. Assessment & Counseling: A network of 54,000+ mental health providers throughout the United States is available to provide in-person assessment and counseling services to members wherever they may reside. Counselors may also conduct comprehensive assessments by phone and provide in-themoment telephonic support and crisis intervention. Tele-Language Services: Deer Oaks has the ability to provide therapy in a language other than English if requested. Services are available for telephonic interpretation in over 190 of the most commonly spoken languages and dialects. Referrals & Community Resources: Counselors provide referrals to community resources, member health plans, support groups, legal resources, and child/elder care services. Advantage Legal Assist: Free 30-minute telephonic consultation with a plan attorney; free 30-minute in-person consultation; 25% discount on hourly attorney fees if representation is required; unlimited online access to a wealth of educational legal resources, links, tools and forms; interactive online Simple Will preparation; access to state agencies to obtain birth certificates and other records. Advantage Financial Assist: Unlimited telephonic consultation with a financial counselor qualified to advise on a range of financial issues such as bankruptcy prevention, debt reduction and financial planning; supporting educational materials available; credit report review by a financial counselor and tips for improvement; objective, pressure-free advice; unlimited online access to a wealth of educational financial resources, links, tools and forms (i.e. tax guides, financial calculators, etc.). Interactive Online Simple Will Preparation: Create a legallybinding simple state specific will at no cost through a step by step online "interview process." Access this service through www.deeroaks.com

Credit Monitoring: Free credit reports and credit monitoring available via the legal/financial center ID Recovery: Free 30-minute telephonic consultation with an Identity Recovery Professional; customized action plan and consultation; ongoing ID recovery guidance available as needed; free ID monitoring service. Monthly Electronic Newsletters: Employees and supervisors receive monthly e-newsletters covering a variety of topics including health and wellness, work/life balance issues, conflict resolution, leadership, and more. Online Tools & Resources: Log on to www.deeroaks.com to access an extensive topical library containing health and wellness articles, child and elder care resources, work/life balance resources and webinars. Contact (866)327-2400 / eap@deeroaks.com Work/Life Services: Work/Life Consultants are available to assist members with a wide range of daily living resources such as pet sitters, event planners, home repair, tutors and moving services. Simply call the Helpline for resource and referral information. Find-Now Child & Elder Care Program: This program assists participants caring for children and/or aging parents with the search for licensed, regulated, and inspected child and elder care facilities in their area. Work/Life Consultants assess each member's needs, provide guidance, resources, and a list of up to three (3) referrals within 12 hours of the call. Searchable databases and other resources are also available on the Deer Oaks website. Health & Wellbeing: Deer Oaks encourages not only the mental health, but also the physical health and wellbeing of our members. Work/Life Consultants are available to provide referrals to providers, specialists, and resources to meet specific needs such as safety programs, support groups, fitness centers and nutrition programs. Critical Incident Stress Management: Traumatic events can be extremely disruptive to the well-being and productivity of employees. Deer Oaks will respond quickly when asked to provide Critical Incident Stress Management Services for any major company incident. Take the High Road: Deer Oaks reimburses members for their cab fares in the event that they are incapacitated due to impairment by a substance or extreme emotional condition. This service is available once per year per participant with a maximum reimbursement of $45.00 (excludes tips).

NBS

FSA (Flexible Spending Account)

YOUR BENEFITS PACKAGE

About this Benefit A Cafeteria Plan is designed to take advantage of Section 125 of the Internal Revenue Code. It allows you to pay certain qualified expenses on a pre-tax basis, thereby reducing your taxable income. You can set aside a pre-established amount of money per plan year in a Healthcare Flexible Spending Account (FSA). Funds allocated to a healthcare FSA must be used during the plan year or are forfeited unless your plan contains a $500 rollover or grace period provision.

Unlimited FSA (Non HSA Compatible) The funds in the unlimited healthcare FSA can be used to pay for eligible medical expenses like deductibles, co-payments, orthodontics, glasses and contacts. 2021 Contribution Maximums Healthcare: $2,750 Dependent Care: $5,000 Beaumont ISD offers a $500 rollover on this benefit.

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 72 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Beaumont ISD Benefits Website: www.mybenefitshub.com/beaumontisd

FSA (Flexible Spending Account) How do I receive reimbursements? During the course of the plan year, you may submit requests for reimbursement of expenses you have incurred. Expenses are Congratulations! considered "incurred" when the service is performed, not Your employer has established a "flexible benefits plan" to help necessarily when it is paid for. You can get submit a claim online you pay for your out-of-pocket health and daycare expenses. at: my.nbsbeneits.com One of the most important features of the plan is that the Please note: Policies other than company sponsored policies (i.e. benefits being offered are paid for with a portion of your pay spouse’s or dependents’ individual policies) may not be paid before federal income or social security taxes are withheld. This through the flexible beneits plan. Furthermore, qualified longmeans that you will pay less tax and have more money to spend term care insurance plans may not be paid through the flexible and save. However, if you receive a reimbursement for an benefits plan. expense under the plan, you cannot claim a federal income tax NBS Benefits Card credit or deduction on your return. Your employer may Health Flexible spending account: sponsor the use of the The health flexible spending account (FSA) enables you to pay NBS Benefits Card, for expenses allowed under Section 105 and 213(d) of the making access to your Internal Revenue Code which are not covered by our insured flex dollars easier than medical plan. ever. You may use the The most that you can contribute to your Health FSA each plan card to pay merchants year is set by the IRS. This amount can be adjusted for increases or service providers in cost-of-living in accordance with Code Section 125(i)(2). that accept credit cards such as hospitals and pharmacies, so there is no need to pay cash up front then wait for Premium expense plan: reimbursement. A premium expense portion of the plan allows you to use preOrthodontic expenses that are paid fully up-front at the time of tax dollars to pay for specific premiums under various insurance initial service are reimbursable in full after the initial service has programs we offer you. been performed and payment has been made. Ongoing orthodontia payments are reimbursable only as they are paid. Dependent care Flexible spending account: The dependent care flexible spending account (DCFSA) enables Account Information you to pay for out-of-pocket, work-related dependent daycare Participants may call NBS and talk to a representative during our costs. Please see the Summary Plan Description for the regular business hours, Monday-Friday, 7 a.m. to 7 p.m. Central definition of an eligible dependent. The law places limits on the Time. Participants can also obtain account information using the amount of money that can be paid to you in a calendar year. Automated Voice Response Unit, 24 hours a day, 7 days a week Generally, your reimbursement may not exceed the lesser of: at (385) 988-6423 or toll free at (800) 274-0503. For immediate (a) $5,000 (if you are married filing a joint return or you are access to your account information at any time, log on to our head of a household) or $2,500 (if you are married filing website at my.nbsbenefits.com or download the NBS Mobile separate returns); (b) your taxable compensation; (c) your App. spouse's actual or deemed earned income. Also, in order to have the reimbursements made to you and be What can I save with an FSA? excluded from your income, you must provide a statement from FSA No FSA the service provider including the name, address and, in most Annual taxable income $24,000 $24,000 cases, the taxpayer identification number of the service provider as well as the amount of such expense and proof that Health FSA $1,500 $0 the expense has been incurred. Dependent care FSA $1,500 $0 Determining contributions Total pre-tax contributions -$3,000 $0 Before each plan year begins, you will select the benefits you Taxable income after FSA $21,000 $24,000 want and how much contributions should go toward each Income taxes -$6,300 -$7,200 benefit. It is very important that you make these choices carefully based on what you expect to spend on each covered After-tax income $14,700 $16,800 benefit or expense during the plan year. $0 -$3,000 Generally, you cannot change the elections you have made after After-tax health and welfare expenses Take-home pay $14,700 $13,800 the beginning of the plan year. However, there are certain limited situations when you can change your elections if you You saved $900 $0 have a "change in status". Please refer to your Summary Plan Description for a change in status listing.

Plan Highlights Flexible Spending Plans

FSA (Flexible Spending Account) NBS Mobile App When you're on the go, save time and hassle with the NBS Mobile App. Submit claims, check your balances, view transactions, and submit documentation using your device's camera.

Easy and convenient •

•

Designed to work just as other iOS and Android apps which makes it easy to learn and use. Shares user authentication with the NBS portal. Registered users can download the app and log in immediately to gain access to their benefit accounts, with no need to register their phone or your account.

It's secure •

No sensitive account information is ever stored on your mobile device and secure encryption is used to protect all transmissions.

Mobile app features The NBS mobile app supports a wide variety of features, empowering you to proactively manage your account. • View account balances • View claims • View reimbursement history • Submit claims • Submit documentation using your device's camera • Pay providers • Setup a variety of SMS alerts • Edit your personal information • View contribution details • View plan information • View calendar deadlines • Contact a service representative • View Benefits Card information

FSA (Flexible Spending Account) Sample Expenses Medical expenses • • • • • • • •

• • •

Acupuncture Addiction programs Adoption (medical expenses for baby birth) Alternative healer fees Ambulance Body scans Breast pumps Care for mentally handicapped Chiropractor Copayments Crutches

Dental expenses • • • • • • •

•

Artificial teeth Copayments Deductible Dental work Dentures Orthodontia expenses Preventative care at dentist office Bridges, crowns, etc.

Vision expenses • • • • • • • •

Braille - books & magazines Contact lenses Contact lens solutions Eye exams Eye glasses Laser surgery Office fees Guide dog and upkeep/other animal aid

Diabetes (insulin, glucose monitor) Eye patches Fertility treatment First aid (i.e. bandages, gauze) Hearing aids & batteries Hypnosis (for treatment of illness) Incontinence products (i.e. Depends, Serene) Joint support bandages and hosiery Lab fees Monitoring device (blood pressure, cholesterol)

• • • • • • • •

• •

Physical exams Pregnancy tests Prescription drugs Psychiatrist/psychologist (for mental illness) Physical therapy Speech therapy Vaccinations Vaporizers or humidifiers Weight loss program fees (if prescribed by physician) Wheelchair

• • • • • • • •

• •

Items that generally do not qualify for reimbursement • • • • • •

• • • • • •

• • •

Personal hygiene (deodorant, soap, body powder, sanitary products) Addiction products Allergy relief (oral meds, nasal spray) Antacids and heartburn relief Anti-itch and hydrocortisone creams Athlete's foot treatment Arthritis pain relieving creams Cold medicines (i.e. syrups, drops, tablets) Cosmetic surgery Cosmetics (i.e. makeup, lipstick, cotton swabs, cotton balls, baby oil) Counseling (i.e. marriage/family) Dental care - routine (i.e. toothpaste, toothbrushes, dental floss, anti-bacterial mouthwashes, fluoride rinses, teeth whitening/ bleaching) Exercise equipment Fever & pain reducers (i.e. Aspirin, Tylenol) Hair care (i.e. hair color, shampoo, conditioner, brushes, hair loss

• • • • • • •

•

• • • • • •

• •

products) Health club or fitness program fees Homeopathic supplement or herbs Household or domestic help Laser hair removal Laxatives Massage therapy Motion sickness medication Nutritional and dietary supplements (i.e. bars, milkshakes, power drinks, Pedialyte) Skin care (i.e. sun block, moisturizing lotion, lip balm) Sleep aids (i.e. oral meds, snoring strips) Smoking cessation relief (i.e. patches, gum) Stomach & digestive relief (i.e. Pepto- Bismol, Imodium) Tooth and mouth pain relief (Orajel, Anbesol) Vitamins Wart removal medication Weight reduction aids (i.e. Slimfast, appetite suppressant

These expenses may be eligible if they are prescribed by a physician (if medically necessary for a specific condition).

MASA YOUR BENEFITS PACKAGE

Medical Transport

About this Benefit Medical Transport covers emergency transportation to and from appropriate medical facilities by covering the out-of-pocket costs that are not covered by insurance. It includes emergency transportation via ground ambulance, air ambulance and helicopter.

A ground ambulance can cost up to

$2,400

and a helicopter transportation fee can cost

over $30,000

This is a general overview of your plan benefits. If the terms of this outline differ from your policy, the policy will govern. Additional plan 76 details on covered expenses, limitations and exclusions are included in the summary plan description located on the Beaumont Frisco ISD ISD Benefits Benefits Website: Website: www.mybenefitshub.com/beaumontisd www.mybenefitshub.com/friscoisd

Medical Transport Enroll in the Emergent Plus plan today and protect you and your family against the financial burden of massive out-of-pocket ambulance costs, all at an affordable group rate.

EMERGENT PLUS MEMBERSHIP BENEFITS A MASA MTS Membership provides the ultimate peace of mind at an affordable rate for emergency ground and air transportation service within the United States and Canada, regardless of whether the provider is in or out of a given group healthcare benefits network. After the group health plan pays its portion, MASA MTS works with providers to deliver our members $0 in out-ofpocket costs for emergency transport. Emergent Air Transportation In the event of a serious medical emergency, Members have access to emergency air transportation into a medical facility or between medical facilities. Emergent Ground Transportation In the event of a serious medical emergency, Members have access to emergency ground transportation into a medical facility or between medical facilities.

DID YOU KNOW? 25 MILLION PEOPLE are sent to the emergency room through ground or air ambulance every year. Insurance companies may not cover all air and ground ambulance expenses which can result in excessive bills.

$5,000

$60,000

Non-Emergency Inter-Facility Transportation In the event that a member is in stable condition in a medical facility but requires a heightened level of care that is not available at their current medical facility, Members have access to non-emergency air or ground transportation between medical facilities. Repatriation/Recuperation Suppose you or a family member is hospitalized more than 100-miles from your home. In that case, you have benefit coverage for air or ground medical transportation into a medical facility closer to your home for recuperation.

$14 /MONTH Contact Your MASA MTS Representative, Financial Benefit Services to learn more about membership plan options. contactus@fbsbenefits.com 800-583-6908

The information provided in this product sheet is for informational purposes only. The benefits listed, and the descriptions thereof, do not represent the full terms and conditions applicable for usage and may only be offered in some memberships. Premiums vary depending on the benefits selected. Commercial Air and Worldwide coverage are not available in all territories. For a complete list of benefits, premiums, and full terms and conditions please refer to the applicable member service agreement for your territory. MASA MTS products and services are not available where prohibited. For Florida residents, Medical Air Services Association of Florida, Inc. is doing business as MASA MTS and is a prepaid limited health service organization licensed under Chapter 636, Florida Statutes, license number: 65-0265219 operating in Florida at 1250 S. Pine Island Road, Suite 500, Plantation, FL 33324. MASA Global, MASA MTS and MASA TRS are registered trade names of Medical Air Services Association, Inc., an Oklahoma corporation. VER: EPPSLAVS1.050521 SOURCE: Welch, Shari. “Emergency Department Usage Trend Data Can Help Physicians Prepare for Patients.” ACEP Now http://bit.ly/3qBvNrc

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